Provider Demographics
NPI:1295333615
Name:AL-ANANI, AYA AKRAM
Entity type:Individual
Prefix:
First Name:AYA
Middle Name:AKRAM
Last Name:AL-ANANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 W YORKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-7000
Mailing Address - Country:US
Mailing Address - Phone:708-945-4651
Mailing Address - Fax:
Practice Address - Street 1:201 S EDWARDS BLVD
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4507
Practice Address - Country:US
Practice Address - Phone:262-248-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16610-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist