Provider Demographics
NPI:1730827965
Name:KONDOOR, MELWIN THOMAS
Entity type:Individual
Prefix:
First Name:MELWIN
Middle Name:THOMAS
Last Name:KONDOOR
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 1:5706 BUFFALO GAP
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2583
Mailing Address - Country:US
Mailing Address - Phone:713-367-3014
Mailing Address - Fax:
Practice Address - Street 1:2902 PALMER HWY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-6815
Practice Address - Country:US
Practice Address - Phone:409-945-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist