Provider Demographics
NPI:1982947560
Name:GUIRGUIS, ADAM NABIL-IBRAHIM (DPH)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:NABIL-IBRAHIM
Last Name:GUIRGUIS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E BROADWAY ST
Mailing Address - Street 2:APT. A
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-9176
Mailing Address - Country:US
Mailing Address - Phone:347-512-8919
Mailing Address - Fax:
Practice Address - Street 1:1111 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3922
Practice Address - Country:US
Practice Address - Phone:580-226-6978
Practice Address - Fax:580-226-7543
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist