Provider Demographics
NPI:1801102512
Name:ABDULLAYOF, MOMENJAN T (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MOMENJAN
Middle Name:T
Last Name:ABDULLAYOF
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1909
Mailing Address - Country:US
Mailing Address - Phone:207-767-4517
Mailing Address - Fax:
Practice Address - Street 1:225 WATERMAN DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3617
Practice Address - Country:US
Practice Address - Phone:207-899-4600
Practice Address - Fax:207-899-4613
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR 4795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist