Provider Demographics
NPI:1790569713
Name:AL EZZI, AYA
Entity Type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:AL EZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 WINDY ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3203
Mailing Address - Country:US
Mailing Address - Phone:424-382-9864
Mailing Address - Fax:
Practice Address - Street 1:9125 HILLCROFT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-2903
Practice Address - Country:US
Practice Address - Phone:713-271-0998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist