Provider Demographics
NPI:1508507823
Name:DAHER ALKHATIB, ANAS
Entity Type:Individual
Prefix:MR
First Name:ANAS
Middle Name:
Last Name:DAHER ALKHATIB
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 1:360 CYPRESS CREEK PKWY # 395
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3518
Mailing Address - Country:US
Mailing Address - Phone:281-397-6622
Mailing Address - Fax:
Practice Address - Street 1:360 CYPRESS CREEK PKWY # 395
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3518
Practice Address - Country:US
Practice Address - Phone:281-397-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8323401661OtherKROGER PHARMACY