Provider Demographics
NPI:1063980506
Name:AJAM, NOUR ALKHOULI
Entity type:Individual
Prefix:
First Name:NOUR
Middle Name:ALKHOULI
Last Name:AJAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9044 W ELM CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-7817
Mailing Address - Country:US
Mailing Address - Phone:203-600-9214
Mailing Address - Fax:
Practice Address - Street 1:8500 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1869
Practice Address - Country:US
Practice Address - Phone:414-269-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist