Provider Demographics
NPI:1568020907
Name:IBRAHIM, NIZAR F (RPH)
Entity Type:Individual
Prefix:
First Name:NIZAR
Middle Name:F
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S PATTERSON AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2013
Mailing Address - Country:US
Mailing Address - Phone:805-453-8801
Mailing Address - Fax:
Practice Address - Street 1:3605 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-2521
Practice Address - Country:US
Practice Address - Phone:805-687-1376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist