Provider Demographics
NPI:1699413559
Name:FARHAT, IBRAHIM ALI (RPH)
Entity type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:ALI
Last Name:FARHAT
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 1:1109 CONEY ISLAND AVE THE MEDICINE SHOPPE PHARMACY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:718-434-4649
Mailing Address - Fax:718-434-4168
Practice Address - Street 1:1109 CONEY ISLAND AVE THE MEDICINE SHOPPE PHARMACY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:718-434-4649
Practice Address - Fax:718-434-4168
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-21
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036310-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist