Provider Demographics
NPI:1831368315
Name:IBRAHIM, ELWALEED MUBARAK (RPH)
Entity type:Individual
Prefix:
First Name:ELWALEED
Middle Name:MUBARAK
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 1:3223 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4213
Mailing Address - Country:US
Mailing Address - Phone:718-856-8048
Mailing Address - Fax:718-469-0424
Practice Address - Street 1:3223 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4213
Practice Address - Country:US
Practice Address - Phone:718-856-8048
Practice Address - Fax:718-469-0424
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist