Provider Demographics
NPI:1962100438
Name:YOUSEFI, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:YOUSEFI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:YOUSEFPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 HAYFIELD LN
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250-6899
Mailing Address - Country:US
Mailing Address - Phone:713-492-5734
Mailing Address - Fax:
Practice Address - Street 1:11 STATE RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-6010
Practice Address - Country:US
Practice Address - Phone:207-443-1786
Practice Address - Fax:207-442-6706
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR71346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist