Provider Demographics
NPI:1215370291
Name:PHARMACY OF AMERICA IV INC.
Entity Type:Organization
Organization Name:PHARMACY OF AMERICA IV INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SABRI
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:267-237-1188
Mailing Address - Street 1:4654 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-1420
Mailing Address - Country:US
Mailing Address - Phone:267-237-1188
Mailing Address - Fax:215-744-0333
Practice Address - Street 1:1900 N 9TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122
Practice Address - Country:US
Practice Address - Phone:267-237-1188
Practice Address - Fax:215-744-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy