Provider Demographics
NPI:1740068667
Name:MUSTAFA, DINA TALEB (PHARMD)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:TALEB
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2111
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-2111
Mailing Address - Country:US
Mailing Address - Phone:130-799-6626
Mailing Address - Fax:
Practice Address - Street 1:3355 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5799
Practice Address - Country:US
Practice Address - Phone:307-635-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0024585183500000X
WY4522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist