Provider Demographics
NPI:1780999540
Name:ROFAYEL, KOURY
Entity type:Individual
Prefix:
First Name:KOURY
Middle Name:
Last Name:ROFAYEL
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 1:18624 CARRIAGE WALK CIR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5517
Mailing Address - Country:US
Mailing Address - Phone:240-413-5417
Mailing Address - Fax:301-253-4232
Practice Address - Street 1:9840 MAIN ST
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2040
Practice Address - Country:US
Practice Address - Phone:301-253-6288
Practice Address - Fax:301-253-4232
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist