Provider Demographics
NPI:1295140358
Name:AYOUB, MARIE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:AYOUB
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-2709
Mailing Address - Country:US
Mailing Address - Phone:203-569-6566
Mailing Address - Fax:
Practice Address - Street 1:563 HOPE ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06907-2709
Practice Address - Country:US
Practice Address - Phone:203-569-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010575183500000X
NY056687183500000X
OHRPH.03230891-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist