Provider Demographics
NPI:1558978205
Name:BADR, LAYTH
Entity Type:Individual
Prefix:
First Name:LAYTH
Middle Name:
Last Name:BADR
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:CMR 402 BOX 691
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GEB. 3703
Practice Address - Street 2:
Practice Address - City:LANDSTUHL
Practice Address - State:RLP
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:314-590-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist