Healthcare Provider Details

I. General information

NPI: 1407778517
Provider Name (Legal Business Name): HUSSEIN N AJRAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S VAL VISTA DR
GILBERT AZ
85296-3788
US

IV. Provider business mailing address

3558 E RAVENSWOOD DR
GILBERT AZ
85298-9267
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-6039
  • Fax:
Mailing address:
  • Phone: 403-470-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027956
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: