Provider Demographics
NPI:1548860372
Name:ABDELRAZEK, MOATAZ T (RPH)
Entity type:Individual
Prefix:
First Name:MOATAZ
Middle Name:T
Last Name:ABDELRAZEK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:MOATAZ
Other - Middle Name:TAREK
Other - Last Name:ABD-EL-RAZEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:203 US LOOP 290 W
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833
Mailing Address - Country:US
Mailing Address - Phone:979-830-1023
Mailing Address - Fax:
Practice Address - Street 1:203 US LOOP 290 W
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833
Practice Address - Country:US
Practice Address - Phone:979-830-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist