Provider Demographics
NPI:1104577725
Name:KASSAM, AZHAR RAFIQ (RPH)
Entity type:Individual
Prefix:
First Name:AZHAR
Middle Name:RAFIQ
Last Name:KASSAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 W EL DORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-6502
Mailing Address - Country:US
Mailing Address - Phone:281-286-4471
Mailing Address - Fax:
Practice Address - Street 1:155 W EL DORADO BLVD
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-6502
Practice Address - Country:US
Practice Address - Phone:281-286-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist