Provider Demographics
NPI:1104259571
Name:NOREDDIN, AYMAN
Entity type:Individual
Prefix:
First Name:AYMAN
Middle Name:
Last Name:NOREDDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WILLOWOOD DR APT 104
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4726
Mailing Address - Country:US
Mailing Address - Phone:218-213-3412
Mailing Address - Fax:
Practice Address - Street 1:KITTRELL HL
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23668-0001
Practice Address - Country:US
Practice Address - Phone:757-728-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist