Provider Demographics
NPI:1396340279
Name:IBRAHIM, ISLAM MOHAMED SABRY
Entity type:Individual
Prefix:
First Name:ISLAM
Middle Name:MOHAMED SABRY
Last Name:IBRAHIM
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 1:1320 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3009
Mailing Address - Country:US
Mailing Address - Phone:609-882-4097
Mailing Address - Fax:609-882-4556
Practice Address - Street 1:1320 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3009
Practice Address - Country:US
Practice Address - Phone:609-882-4097
Practice Address - Fax:609-882-4556
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04092000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist