Provider Demographics
NPI:1932711033
Name:NAZZAL, SAMIRA IBRAHIM
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:IBRAHIM
Last Name:NAZZAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10152 LAKE JUNE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-3006
Mailing Address - Country:US
Mailing Address - Phone:469-341-3900
Mailing Address - Fax:
Practice Address - Street 1:10152 LAKE JUNE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-3006
Practice Address - Country:US
Practice Address - Phone:469-341-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist