Provider Demographics
NPI:1336724103
Name:ALBERT, KWAME (CPHT)
Entity Type:Individual
Prefix:MR
First Name:KWAME
Middle Name:
Last Name:ALBERT
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11710 BROADWAY ST STE 120
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4046
Mailing Address - Country:US
Mailing Address - Phone:832-617-8080
Mailing Address - Fax:
Practice Address - Street 1:11710 BROADWAY ST STE 120
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4046
Practice Address - Country:US
Practice Address - Phone:832-617-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109338183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician