Provider Demographics
NPI:1457689507
Name:SIDAROUS, RASHA (RPH)
Entity Type:Individual
Prefix:
First Name:RASHA
Middle Name:
Last Name:SIDAROUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7634 BELLAIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5806
Mailing Address - Country:US
Mailing Address - Phone:713-774-2180
Mailing Address - Fax:713-774-6958
Practice Address - Street 1:7634 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-5806
Practice Address - Country:US
Practice Address - Phone:713-774-2180
Practice Address - Fax:713-774-6958
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist