Provider Demographics
NPI:1073340014
Name:AL ATIA AL HASSAD, MAHMOUD (PHARMD)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:AL ATIA AL HASSAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20105 ALISON TRL
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1707
Mailing Address - Country:US
Mailing Address - Phone:708-328-0844
Mailing Address - Fax:
Practice Address - Street 1:2525 W ANDERSON LN BLDG 2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1142
Practice Address - Country:US
Practice Address - Phone:512-323-6127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist