Provider Demographics
NPI:1346589207
Name:IBRAHIM, NIRMEEN A (RPH)
Entity Type:Individual
Prefix:MS
First Name:NIRMEEN
Middle Name:A
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2539
Mailing Address - Country:US
Mailing Address - Phone:201-317-9835
Mailing Address - Fax:
Practice Address - Street 1:16 POCONO RD STE 115
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2905
Practice Address - Country:US
Practice Address - Phone:862-209-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03065600183500000X
NY048544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist