Provider Demographics
NPI:1710242979
Name:QAISI, SHROUQ KAMEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHROUQ
Middle Name:KAMEL
Last Name:QAISI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 CENTRE CREEK DR STE 115
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5133
Mailing Address - Country:US
Mailing Address - Phone:512-662-3600
Mailing Address - Fax:
Practice Address - Street 1:1295 N MARTIN MEDICATION MANAGEMENT CTR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0001
Practice Address - Country:US
Practice Address - Phone:520-626-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALP16914183500000X
TX60258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist