Provider Demographics
NPI:1861259442
Name:KORISH, MALEK MOHAMED
Entity type:Individual
Prefix:
First Name:MALEK
Middle Name:MOHAMED
Last Name:KORISH
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 1:4014 LODGE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8687
Mailing Address - Country:US
Mailing Address - Phone:346-308-0735
Mailing Address - Fax:
Practice Address - Street 1:725 E VILLA MARIA RD STE 1300
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5320
Practice Address - Country:US
Practice Address - Phone:979-822-1850
Practice Address - Fax:979-775-6872
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician