Provider Demographics
NPI:1063108553
Name:MAZZ, DAANISH KAMAL (PHARMD)
Entity type:Individual
Prefix:
First Name:DAANISH
Middle Name:KAMAL
Last Name:MAZZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:DAANISH
Other - Middle Name:MAAZ
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14882 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7715
Mailing Address - Country:US
Mailing Address - Phone:210-764-8368
Mailing Address - Fax:210-764-8715
Practice Address - Street 1:14882 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7715
Practice Address - Country:US
Practice Address - Phone:210-764-8368
Practice Address - Fax:210-764-8715
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist