Provider Demographics
NPI:1942584735
Name:KOUYATE, OUSMANE
Entity Type:Individual
Prefix:DR
First Name:OUSMANE
Middle Name:
Last Name:KOUYATE
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 1:6009 PINEHURST RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2919
Mailing Address - Country:US
Mailing Address - Phone:410-532-8071
Mailing Address - Fax:
Practice Address - Street 1:6009 PINEHURST RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2919
Practice Address - Country:US
Practice Address - Phone:410-532-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist