Provider Demographics
NPI:1821677832
Name:SHAABI, MIRA (RPH)
Entity Type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:SHAABI
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 1:4107 BELMONT SHORE LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5009
Mailing Address - Country:US
Mailing Address - Phone:832-638-8360
Mailing Address - Fax:
Practice Address - Street 1:3640 GLENN LAKES LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4064
Practice Address - Country:US
Practice Address - Phone:281-261-8278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32157OtherTEXAS REGISTERD PHARMACIST LICENSE NUMBER