Healthcare Provider Details

I. General information

NPI: 1255653564
Provider Name (Legal Business Name): NARGIS AYOUB PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 WEST MAIN ST.
PATCHOGUE NY
11772
US

IV. Provider business mailing address

286 WEST MAIN ST.
PATCHOGUE NY
11772
US

V. Phone/Fax

Practice location:
  • Phone: 631-576-8141
  • Fax: 631-576-8147
Mailing address:
  • Phone: 631-576-8141
  • Fax: 631-576-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00056559
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number054480
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: