Provider Demographics
NPI:1427476936
Name:IBRAHIM, BADR MOSTAFA (RPH)
Entity type:Individual
Prefix:
First Name:BADR
Middle Name:MOSTAFA
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-1634
Mailing Address - Country:US
Mailing Address - Phone:252-747-2381
Mailing Address - Fax:
Practice Address - Street 1:905 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1634
Practice Address - Country:US
Practice Address - Phone:252-747-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist