Provider Demographics
NPI:1497049530
Name:MURUSAL IBRAHIM, MUNAVVARA BINTI (RPH)
Entity Type:Individual
Prefix:MS
First Name:MUNAVVARA
Middle Name:BINTI
Last Name:MURUSAL 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:PO BOX 1732
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-1732
Mailing Address - Country:US
Mailing Address - Phone:407-592-4290
Mailing Address - Fax:
Practice Address - Street 1:1992 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1942
Practice Address - Country:US
Practice Address - Phone:727-938-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist