Provider Demographics
NPI:1326411505
Name:CHEEMA, KALSOOM NAZ
Entity Type:Individual
Prefix:
First Name:KALSOOM NAZ
Middle Name:
Last Name:CHEEMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17903 BELLA AVA DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-2377
Mailing Address - Country:US
Mailing Address - Phone:832-205-6202
Mailing Address - Fax:
Practice Address - Street 1:17903 BELLA AVA DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-2377
Practice Address - Country:US
Practice Address - Phone:832-205-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist