Provider Demographics
NPI:1285259887
Name:TAKIEDDINE, AYA (PHARMD)
Entity type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:TAKIEDDINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AYA
Other - Middle Name:
Other - Last Name:TAKIEDDINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2509 WHITE TAIL DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7222
Mailing Address - Country:US
Mailing Address - Phone:319-553-0206
Mailing Address - Fax:
Practice Address - Street 1:2509 WHITE TAIL DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-7222
Practice Address - Country:US
Practice Address - Phone:319-553-0206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist