Provider Demographics
NPI:1255065769
Name:ALQWASMI, ASEEL NABEEL ABDEL GHANI
Entity type:Individual
Prefix:
First Name:ASEEL
Middle Name:NABEEL ABDEL GHANI
Last Name:ALQWASMI
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 1:4305 E PLATTE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-4104
Mailing Address - Country:US
Mailing Address - Phone:719-622-1726
Mailing Address - Fax:719-622-9219
Practice Address - Street 1:4305 E PLATTE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-4104
Practice Address - Country:US
Practice Address - Phone:719-622-1726
Practice Address - Fax:719-622-9219
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0024042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist