Provider Demographics
NPI:1730703661
Name:MOATAZ PHARMACUTICALS
Entity type:Organization
Organization Name:MOATAZ PHARMACUTICALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOATAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:METWALLY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:469-656-1111
Mailing Address - Street 1:1201 W MCDERMOTT DR STE 111
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6394
Mailing Address - Country:US
Mailing Address - Phone:469-656-1111
Mailing Address - Fax:469-656-1003
Practice Address - Street 1:1201 W MCDERMOTT DR STE 111
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6394
Practice Address - Country:US
Practice Address - Phone:469-656-1111
Practice Address - Fax:469-656-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-06
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy