Provider Demographics
NPI:1730458506
Name:KORAYIM, WALID MOSTAFA (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALID
Middle Name:MOSTAFA
Last Name:KORAYIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:WALID
Other - Middle Name:MOSTAFA
Other - Last Name:KORAYIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:34 ANTHONY LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2824
Mailing Address - Country:US
Mailing Address - Phone:609-275-8490
Mailing Address - Fax:
Practice Address - Street 1:34 ANTHONY LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2824
Practice Address - Country:US
Practice Address - Phone:609-275-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048270OtherPHRMACIST
NY048270OtherPHRMACIST