Provider Demographics
NPI:1164745360
Name:MIRE, ABDIRIZAK ALI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ABDIRIZAK
Middle Name:ALI
Last Name:MIRE
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 1:1515 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2137
Mailing Address - Country:US
Mailing Address - Phone:612-874-0575
Mailing Address - Fax:
Practice Address - Street 1:1515 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2137
Practice Address - Country:US
Practice Address - Phone:612-874-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist