Provider Demographics
NPI:1609501451
Name:AL BARRAK, LAILA A
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:A
Last Name:AL BARRAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9816 TRAVER ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1869
Mailing Address - Country:US
Mailing Address - Phone:517-505-2958
Mailing Address - Fax:
Practice Address - Street 1:9816 TRAVER ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1869
Practice Address - Country:US
Practice Address - Phone:517-505-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist