Provider Demographics
NPI:1689226151
Name:RATRUT, KHALID ZIYAD (RPH)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:ZIYAD
Last Name:RATRUT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 WURZBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2212
Mailing Address - Country:US
Mailing Address - Phone:210-696-1073
Mailing Address - Fax:210-699-8760
Practice Address - Street 1:9900 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2212
Practice Address - Country:US
Practice Address - Phone:210-696-1073
Practice Address - Fax:210-699-8760
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist