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General NPI Number Information
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NPI Number | 1407198757
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Entity Type | Individual
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Provider Name | JACK E AYOUB R.PH.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 2155 PAREDES LINE RD HEB PHARMACY,#446
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City | BROWNSVILLE
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State | TX
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Zip | 78521-1609
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Country | US
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Telephone | 956-574-9707
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Fax | 956-574-9715
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Provider Business Mailing Address
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Address Line | 2420 E WASHINGTON AVE
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City | HARLINGEN
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State | TX
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Zip | 78550-2731
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Country | US
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Telephone | 956-574-9707
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Fax | 956-574-9715
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 20734
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License Number State | TX
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