Provider Demographics
NPI:1053828475
Name:ALJUBOORI, AYAT
Entity Type:Individual
Prefix:
First Name:AYAT
Middle Name:
Last Name:ALJUBOORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 E SPEEDWAY BLVD APT 4240
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1791
Mailing Address - Country:US
Mailing Address - Phone:413-557-0027
Mailing Address - Fax:
Practice Address - Street 1:3901 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2206
Practice Address - Country:US
Practice Address - Phone:520-918-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKS023065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS023065OtherPHARMACIST LICENSE