Provider Demographics
NPI:1356678346
Name:ALDAQS, KHOLOUD M
Entity Type:Individual
Prefix:
First Name:KHOLOUD
Middle Name:M
Last Name:ALDAQS
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 1:750 N WALNUT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3208
Mailing Address - Country:US
Mailing Address - Phone:817-477-5271
Mailing Address - Fax:
Practice Address - Street 1:750 N WALNUT CREEK DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3208
Practice Address - Country:US
Practice Address - Phone:817-477-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist