Provider Demographics
NPI:1154610277
Name:O'BANYOUN, AZALIAH BITHIAH (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:AZALIAH
Middle Name:BITHIAH
Last Name:O'BANYOUN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 HALSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-3613
Mailing Address - Country:US
Mailing Address - Phone:914-835-3463
Mailing Address - Fax:
Practice Address - Street 1:270 HALSTEAD AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-3613
Practice Address - Country:US
Practice Address - Phone:914-835-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist