Provider Demographics
NPI:1184038424
Name:NOUBISSI, JEAN P (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEAN P
Middle Name:
Last Name:NOUBISSI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 N FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2504
Mailing Address - Country:US
Mailing Address - Phone:301-948-3250
Mailing Address - Fax:301-519-9424
Practice Address - Street 1:546 N FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2504
Practice Address - Country:US
Practice Address - Phone:301-948-3250
Practice Address - Fax:301-519-9424
Is Sole Proprietor?:No
Enumeration Date:2014-06-15
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0652244OtherCVS/CAREMARK