Provider Demographics
NPI:1043959737
Name:GHATTAS, AYMAN G
Entity type:Individual
Prefix:
First Name:AYMAN
Middle Name:G
Last Name:GHATTAS
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 1:3529 BEEKMAN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-9429
Mailing Address - Country:US
Mailing Address - Phone:816-267-1905
Mailing Address - Fax:
Practice Address - Street 1:1592 S LOOP 288
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4730
Practice Address - Country:US
Practice Address - Phone:940-566-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist