Provider Demographics
NPI:1851768808
Name:TABASSUM, RUBAIYAT
Entity Type:Individual
Prefix:
First Name:RUBAIYAT
Middle Name:
Last Name:TABASSUM
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 1:15770 BELLAIRE BLVD APT 1001
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-3006
Mailing Address - Country:US
Mailing Address - Phone:832-782-7858
Mailing Address - Fax:
Practice Address - Street 1:1600 JACKSON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3248
Practice Address - Country:US
Practice Address - Phone:281-342-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist