Provider Demographics
NPI:1487962718
Name:BANOUB, HAIDY M (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:HAIDY
Middle Name:M
Last Name:BANOUB
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6970 CRESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7239
Mailing Address - Country:US
Mailing Address - Phone:301-682-9158
Mailing Address - Fax:
Practice Address - Street 1:6970 CRESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7239
Practice Address - Country:US
Practice Address - Phone:301-682-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist