Provider Demographics
NPI:1336803519
Name:ELEMAM, MAHMOUD
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:ELEMAM
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 1:12534 FLEET RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-2210
Mailing Address - Country:US
Mailing Address - Phone:919-271-2726
Mailing Address - Fax:
Practice Address - Street 1:508 MURPHY RD E
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5449
Practice Address - Country:US
Practice Address - Phone:832-678-7100
Practice Address - Fax:832-678-7101
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist