Provider Demographics
NPI:1376144253
Name:MEDIOUNI, MALEK (PHARMD)
Entity Type:Individual
Prefix:
First Name:MALEK
Middle Name:
Last Name:MEDIOUNI
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 1:145 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9309
Mailing Address - Country:US
Mailing Address - Phone:207-885-3040
Mailing Address - Fax:
Practice Address - Street 1:145 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9309
Practice Address - Country:US
Practice Address - Phone:207-885-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR6024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist