Provider Demographics
NPI:1851627046
Name:HATTAB, MARWAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARWAN
Middle Name:
Last Name:HATTAB
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 1:6904 OCEANO TER
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3568
Mailing Address - Country:US
Mailing Address - Phone:817-966-0140
Mailing Address - Fax:
Practice Address - Street 1:6904 OCEANO TER
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3568
Practice Address - Country:US
Practice Address - Phone:817-966-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40326183500000X
MA23512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist