Provider Demographics
NPI:1316611890
Name:ABDURRAHMAN, KHADIJA MAHMOUD
Entity type:Individual
Prefix:
First Name:KHADIJA
Middle Name:MAHMOUD
Last Name:ABDURRAHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 W FREDDY GONZALEZ DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5327
Mailing Address - Country:US
Mailing Address - Phone:956-287-9183
Mailing Address - Fax:956-287-9187
Practice Address - Street 1:1520 W FREDDY GONZALEZ DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5327
Practice Address - Country:US
Practice Address - Phone:956-287-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist