Provider Demographics
NPI:1760488274
Name:ELBOLBOL, NADA KAMAL (RPH)
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:KAMAL
Last Name:ELBOLBOL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 SHADOWFERN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2378
Mailing Address - Country:US
Mailing Address - Phone:713-667-5466
Mailing Address - Fax:713-272-5550
Practice Address - Street 1:6630 DEMOSS
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-272-5555
Practice Address - Fax:713-272-5550
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist