Healthcare Provider Details

I. General information

NPI: 1346426673
Provider Name (Legal Business Name): MR. AYMAN A. AZAB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 EASTERN AVE
SCHENECTADY NY
12308-3501
US

IV. Provider business mailing address

1129 FERNWOOD DR
NISKAYUNA NY
12309-2707
US

V. Phone/Fax

Practice location:
  • Phone: 518-393-4549
  • Fax:
Mailing address:
  • Phone: 518-631-0284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: