Provider Demographics
NPI:1255653564
Name:AYOUB, NARGIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:NARGIS
Middle Name:
Last Name:AYOUB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 WEST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-576-8141
Mailing Address - Fax:631-576-8147
Practice Address - Street 1:286 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-576-8141
Practice Address - Fax:631-576-8147
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00056559183500000X
NY054480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist