Provider Demographics
NPI:1598552770
Name:IBRAHIM, ESSRAA BAHAAELDIN HASAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ESSRAA
Middle Name:BAHAAELDIN HASAN
Last Name:IBRAHIM
Suffix:
Gender:
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 102ND ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4524
Mailing Address - Country:US
Mailing Address - Phone:294-829-3649
Mailing Address - Fax:
Practice Address - Street 1:3506 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4623
Practice Address - Country:US
Practice Address - Phone:718-777-8544
Practice Address - Fax:718-777-8546
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist