=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780999540
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KOURY ROFAYEL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2010
-----------------------------------------------------
Last Update Date | 08/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9840 MAIN ST
-----------------------------------------------------
City | DAMASCUS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20872-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-253-6288
-----------------------------------------------------
Fax | 301-253-4232
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18624 CARRIAGE WALK CIR
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20879-5517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-413-5417
-----------------------------------------------------
Fax | 301-253-4232
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 18530
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------