Provider Demographics
NPI:1154918399
Name:DALAQ, MOHAMMAD NABIL (PHARMD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:NABIL
Last Name:DALAQ
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 1:7773 KINGS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-7118
Mailing Address - Country:US
Mailing Address - Phone:214-440-7426
Mailing Address - Fax:
Practice Address - Street 1:5920 W PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4304
Practice Address - Country:US
Practice Address - Phone:972-248-7572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist