Provider Demographics
NPI:1093560294
Name:ELEBIARY, NOURA MOHAMED IBRAHIM
Entity type:Individual
Prefix:
First Name:NOURA
Middle Name:MOHAMED IBRAHIM
Last Name:ELEBIARY
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 1:14845 DURDEN CT
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-9266
Mailing Address - Country:US
Mailing Address - Phone:530-887-1316
Mailing Address - Fax:
Practice Address - Street 1:1005 SUTTON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5182
Practice Address - Country:US
Practice Address - Phone:530-272-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH89377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist