Provider Demographics
NPI:1063228583
Name:IBIS, TRIXY
Entity type:Individual
Prefix:
First Name:TRIXY
Middle Name:
Last Name:IBIS
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 1:2220 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4270
Mailing Address - Country:US
Mailing Address - Phone:916-789-0807
Mailing Address - Fax:916-789-0809
Practice Address - Street 1:2220 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4270
Practice Address - Country:US
Practice Address - Phone:916-789-0807
Practice Address - Fax:916-789-0809
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist