Provider Demographics
NPI:1194327387
Name:IBRAHIM, DINA (PHARM-D)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 BRACKENHURST PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4609
Mailing Address - Country:US
Mailing Address - Phone:407-580-3397
Mailing Address - Fax:
Practice Address - Street 1:1750 BRACKENHURST PL
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4609
Practice Address - Country:US
Practice Address - Phone:407-580-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist