Provider Demographics
NPI:1558605147
Name:ALI, FARISA F
Entity Type:Individual
Prefix:
First Name:FARISA
Middle Name:F
Last Name:ALI
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 1:6217 DUCHESS AVE
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1012
Mailing Address - Country:US
Mailing Address - Phone:571-224-7034
Mailing Address - Fax:
Practice Address - Street 1:991 NORTH WILLIS STREET
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603
Practice Address - Country:US
Practice Address - Phone:325-676-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist