Provider Demographics
NPI:1467170175
Name:IBRAHIM, MENNATALLAH MOUNIR SAYED MOHAMED
Entity Type:Individual
Prefix:
First Name:MENNATALLAH
Middle Name:MOUNIR SAYED MOHAMED
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GILBERT DR APT 203
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-2747
Mailing Address - Country:US
Mailing Address - Phone:540-449-5239
Mailing Address - Fax:
Practice Address - Street 1:8 GILBERT DR APT 203
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-2747
Practice Address - Country:US
Practice Address - Phone:540-449-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-01295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist