Provider Demographics
NPI:1902038540
Name:SARSOUR, AL-AMIR-IBRAHIM SAMIR (PHARMD)
Entity Type:Individual
Prefix:
First Name:AL-AMIR-IBRAHIM
Middle Name:SAMIR
Last Name:SARSOUR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1515
Mailing Address - Country:US
Mailing Address - Phone:252-522-4811
Mailing Address - Fax:252-522-4828
Practice Address - Street 1:701 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1515
Practice Address - Country:US
Practice Address - Phone:252-522-4811
Practice Address - Fax:252-522-4828
Is Sole Proprietor?:No
Enumeration Date:2009-08-16
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist