Provider Demographics
NPI:1063012821
Name:MOHSEN, IBRAHIM (PHARMD)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:
Last Name:MOHSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 THF BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1123
Mailing Address - Country:US
Mailing Address - Phone:636-536-4604
Mailing Address - Fax:636-532-0900
Practice Address - Street 1:100 THF BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1123
Practice Address - Country:US
Practice Address - Phone:636-536-4604
Practice Address - Fax:636-532-0900
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015029225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist