Basic Information
Provider Information
NPI: 1184083511
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMADAN
FirstName: IMAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 701 LEGACY DR APT 1221
Address2:  
City: PLANO
State: TX
PostalCode: 750232236
CountryCode: US
TelephoneNumber: 2149123238
FaxNumber:  
Practice Location
Address1: 2636 W WALNUT ST STE 300
Address2:  
City: GARLAND
State: TX
PostalCode: 750426441
CountryCode: US
TelephoneNumber: 2147039000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/12/2016
LastUpdateDate: 02/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X56033TXY Pharmacy Service ProvidersPharmacist 

No ID Information.


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