Provider Demographics
NPI:1639760325
Name:SHEHZADI NAGRA MD PLLC
Entity Type:Organization
Organization Name:SHEHZADI NAGRA MD PLLC
Other - Org Name:SHEHZADI NAGRA MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-723-9226
Mailing Address - Street 1:1601 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5619
Mailing Address - Country:US
Mailing Address - Phone:940-723-9226
Mailing Address - Fax:940-723-9217
Practice Address - Street 1:1601 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5619
Practice Address - Country:US
Practice Address - Phone:940-723-9226
Practice Address - Fax:940-723-9217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEHZADI NAGRA MD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-27
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33625OtherPHARMACY LIC