Provider Demographics
NPI:1528408606
Name:AL-JUNDI, MADA (RPH)
Entity Type:Individual
Prefix:
First Name:MADA
Middle Name:
Last Name:AL-JUNDI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MADA
Other - Middle Name:ALJUNDI
Other - Last Name:IBRIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19534 CLAY OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3004
Mailing Address - Country:US
Mailing Address - Phone:210-241-9614
Mailing Address - Fax:
Practice Address - Street 1:19534 CLAY OAK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3004
Practice Address - Country:US
Practice Address - Phone:210-241-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist