Provider Demographics
NPI:1346614146
Name:ALLY, AYUBE OMAR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AYUBE
Middle Name:OMAR
Last Name:ALLY
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 1:9 AUTUMN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5825
Mailing Address - Country:US
Mailing Address - Phone:603-566-2508
Mailing Address - Fax:
Practice Address - Street 1:12215 DARNESTOWN RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2203
Practice Address - Country:US
Practice Address - Phone:301-948-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist