Provider Demographics
NPI:1346891280
Name:ALDAHAN, MOSTAFA
Entity Type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:
Last Name:ALDAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 FM 1463 RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5459
Mailing Address - Country:US
Mailing Address - Phone:281-712-4979
Mailing Address - Fax:281-712-4980
Practice Address - Street 1:4010 FM 1463 RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5459
Practice Address - Country:US
Practice Address - Phone:281-712-4979
Practice Address - Fax:281-712-4980
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist