Provider Demographics
NPI:1518407550
Name:IBRAHIM, NEVEEN SHOUKRY
Entity type:Individual
Prefix:
First Name:NEVEEN
Middle Name:SHOUKRY
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13177 SLEEPY WIND ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2932
Mailing Address - Country:US
Mailing Address - Phone:805-298-6034
Mailing Address - Fax:
Practice Address - Street 1:2303 E VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2183
Practice Address - Country:US
Practice Address - Phone:805-983-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist