Provider Demographics
NPI:1629319090
Name:MUKALEL, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MUKALEL
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 1:1310 JASMINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-3402
Mailing Address - Country:US
Mailing Address - Phone:832-633-3998
Mailing Address - Fax:
Practice Address - Street 1:1310 JASMINE AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-3402
Practice Address - Country:US
Practice Address - Phone:832-633-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist