Provider Demographics
NPI:1518357045
Name:ALRUBAYE, HAYDER
Entity type:Individual
Prefix:
First Name:HAYDER
Middle Name:
Last Name:ALRUBAYE
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 1:2204 CASTLE ROCK SQ APT 12C
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-6014
Mailing Address - Country:US
Mailing Address - Phone:571-477-7100
Mailing Address - Fax:
Practice Address - Street 1:3333 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6565
Practice Address - Country:US
Practice Address - Phone:406-652-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-47253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350062837013Medicaid