Provider Demographics
NPI:1033932207
Name:ATTA, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:ATTA
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 1:6105 BEVERLYHILL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-6715
Mailing Address - Country:US
Mailing Address - Phone:832-487-9746
Mailing Address - Fax:
Practice Address - Street 1:6105 BEVERLYHILL ST STE 2
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6715
Practice Address - Country:US
Practice Address - Phone:832-487-9746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX740391835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations