Provider Demographics
NPI:1912055575
Name:AYZA LLC
Entity Type:Organization
Organization Name:AYZA LLC
Other - Org Name:KINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZUBAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-549-1900
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-0256
Mailing Address - Country:US
Mailing Address - Phone:410-549-1900
Mailing Address - Fax:410-549-3776
Practice Address - Street 1:7627 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-8939
Practice Address - Country:US
Practice Address - Phone:410-549-1900
Practice Address - Fax:410-549-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP047373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417556500Medicaid
2033691OtherPK