Provider Demographics
NPI:1205468386
Name:NOFAL, NEVEEN (RPH)
Entity type:Individual
Prefix:
First Name:NEVEEN
Middle Name:
Last Name:NOFAL
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 1:500 AVALANCHE DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3675
Mailing Address - Country:US
Mailing Address - Phone:865-765-1771
Mailing Address - Fax:
Practice Address - Street 1:1408 SUMMIT AVE STE 2
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8135
Practice Address - Country:US
Practice Address - Phone:972-726-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist