Provider Demographics
NPI:1114638509
Name:ALRAYASHI, SAM
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:ALRAYASHI
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 1:2700 BLANKENBAKER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2478
Mailing Address - Country:US
Mailing Address - Phone:855-647-7379
Mailing Address - Fax:
Practice Address - Street 1:1250 PATROL RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-8670
Practice Address - Country:US
Practice Address - Phone:855-647-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413867183500000X
NV21860183500000X
IN26028499A183500000X
VA0202220840183500000X
KY020326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist