Provider Demographics
NPI:1467955740
Name:ALBAYATI, NASSAR
Entity Type:Individual
Prefix:
First Name:NASSAR
Middle Name:
Last Name:ALBAYATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7948
Mailing Address - Country:US
Mailing Address - Phone:918-246-0510
Mailing Address - Fax:
Practice Address - Street 1:405 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7948
Practice Address - Country:US
Practice Address - Phone:918-246-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist