Provider Demographics
NPI:1205548039
Name:ANTOUN, MARY GAMAL GEORGE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GAMAL GEORGE
Last Name:ANTOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK DR APT 1037
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7434
Mailing Address - Country:US
Mailing Address - Phone:267-300-1344
Mailing Address - Fax:
Practice Address - Street 1:2501 MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7606
Practice Address - Country:US
Practice Address - Phone:501-404-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04243000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist