Provider Demographics
NPI:1205164100
Name:FATI, AHMED SAMY
Entity type:Individual
Prefix:MR
First Name:AHMED SAMY
Middle Name:
Last Name:FATI
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 1:9625 WHITE SETTLEMENT RD
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9625 WHITE SETTLEMENT RD
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4406
Practice Address - Country:US
Practice Address - Phone:817-367-3469
Practice Address - Fax:817-367-3560
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist