Provider Demographics
NPI:1679819114
Name:AL NABKI, FAHED OMAR
Entity Type:Individual
Prefix:
First Name:FAHED
Middle Name:OMAR
Last Name:AL NABKI
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 1:4550 N MAJOR DR
Mailing Address - Street 2:APT#1221
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8587
Mailing Address - Country:US
Mailing Address - Phone:409-466-6804
Mailing Address - Fax:
Practice Address - Street 1:3885 N. DOWLEN RD.
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706
Practice Address - Country:US
Practice Address - Phone:409-924-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist