Provider Demographics
NPI:1891387437
Name:AL-MUQBEL, AL-MUTAZ
Entity Type:Individual
Prefix:
First Name:AL-MUTAZ
Middle Name:
Last Name:AL-MUQBEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SCOFIELD RIDGE PKWY APT 924
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-7609
Mailing Address - Country:US
Mailing Address - Phone:210-712-0728
Mailing Address - Fax:
Practice Address - Street 1:8500 SHOAL CREEK BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6888
Practice Address - Country:US
Practice Address - Phone:512-617-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX66700OtherTEXAS BOARD OF PHARMACIST LICENSE