Provider Demographics
NPI:1801230289
Name:FAYED, AYMAN M
Entity Type:Individual
Prefix:
First Name:AYMAN
Middle Name:M
Last Name:FAYED
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 1:1005 POTOMAC RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8489
Mailing Address - Country:US
Mailing Address - Phone:980-226-7720
Mailing Address - Fax:
Practice Address - Street 1:2210 LAURENS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3224
Practice Address - Country:US
Practice Address - Phone:864-288-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22306183500000X
SC13652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist