Provider Demographics
NPI:1306685458
Name:BERAKI, ADAL
Entity type:Individual
Prefix:
First Name:ADAL
Middle Name:
Last Name:BERAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 S INTERSTATE 35 APT 1925
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-2650
Mailing Address - Country:US
Mailing Address - Phone:504-503-3593
Mailing Address - Fax:
Practice Address - Street 1:2950 DOWLEN RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7226
Practice Address - Country:US
Practice Address - Phone:409-861-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist