Provider Demographics
NPI:1265748743
Name:AHMADI, KOOROSH
Entity type:Individual
Prefix:
First Name:KOOROSH
Middle Name:
Last Name:AHMADI
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 1:619 BENDING BOUGH DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-5499
Mailing Address - Country:US
Mailing Address - Phone:832-693-6477
Mailing Address - Fax:
Practice Address - Street 1:10375 RICHMOND AVE
Practice Address - Street 2:SUITE 1575
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4143
Practice Address - Country:US
Practice Address - Phone:713-541-1177
Practice Address - Fax:713-513-5924
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist