Provider Demographics
NPI:1407198757
Name:AYOUB, JACK E (RPH)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:E
Last Name:AYOUB
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2731
Mailing Address - Country:US
Mailing Address - Phone:956-574-9707
Mailing Address - Fax:956-574-9715
Practice Address - Street 1:2155 PAREDES LINE RD
Practice Address - Street 2:HEB PHARMACY,#446
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-1609
Practice Address - Country:US
Practice Address - Phone:956-574-9707
Practice Address - Fax:956-574-9715
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist