Provider Demographics
NPI:1053914259
Name:FATIH, MUSTAFA
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:FATIH
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 1:12601 TOMBALL PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-3326
Mailing Address - Country:US
Mailing Address - Phone:281-272-7190
Mailing Address - Fax:281-272-7196
Practice Address - Street 1:12601 TOMBALL PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-3326
Practice Address - Country:US
Practice Address - Phone:281-272-7190
Practice Address - Fax:281-272-7196
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist