Provider Demographics
NPI:1770810921
Name:ISLAM, KAZI SAIFUL
Entity type:Individual
Prefix:DR
First Name:KAZI
Middle Name:SAIFUL
Last Name:ISLAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KAZI
Other - Middle Name:
Other - Last Name:ISLAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:13022 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5202
Mailing Address - Country:US
Mailing Address - Phone:972-386-4649
Mailing Address - Fax:972-490-6183
Practice Address - Street 1:13022 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5202
Practice Address - Country:US
Practice Address - Phone:972-386-4649
Practice Address - Fax:972-490-6183
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist