Provider Demographics
NPI:1174387799
Name:OUK, MACMONI H (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MACMONI
Middle Name:H
Last Name:OUK
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:MAC
Other - Middle Name:H
Other - Last Name:OUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:9501 GARDEN WOOD DR APT 314
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-4716
Mailing Address - Country:US
Mailing Address - Phone:469-615-8259
Mailing Address - Fax:
Practice Address - Street 1:12600 N BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4200
Practice Address - Country:US
Practice Address - Phone:817-562-3901
Practice Address - Fax:817-562-3903
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist