Provider Demographics
NPI:1649873555
Name:YACOUB, AMIR
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:YACOUB
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 1:300 EDEN CIR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4303
Mailing Address - Country:US
Mailing Address - Phone:302-832-0156
Mailing Address - Fax:844-411-6342
Practice Address - Street 1:300 EDEN CIR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-4303
Practice Address - Country:US
Practice Address - Phone:302-832-0156
Practice Address - Fax:844-411-6342
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53057183500000X
VA0202211336183500000X
MD20638183500000X
DEA1-0004681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist