Provider Demographics
NPI:1700573383
Name:KASHASHA, MOSTAFA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:
Last Name:KASHASHA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15902 SEEKERS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3309
Mailing Address - Country:US
Mailing Address - Phone:919-819-5378
Mailing Address - Fax:
Practice Address - Street 1:1515 N LOOP 1604 E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1431
Practice Address - Country:US
Practice Address - Phone:210-491-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist