Provider Demographics
NPI:1568936391
Name:PEDRO, IBRAHEEM (PHARM D)
Entity Type:Individual
Prefix:
First Name:IBRAHEEM
Middle Name:
Last Name:PEDRO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMUNITY OF HOUSTON PHARMACY LLC
Mailing Address - Street 2:3533 S DAIRY ASHFORD RD SUITE G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082
Mailing Address - Country:US
Mailing Address - Phone:832-328-7301
Mailing Address - Fax:832-288-3764
Practice Address - Street 1:3533 S DAIRY ASHFORD RD SUITE G
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:832-328-7301
Practice Address - Fax:832-288-3764
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55829183500000X
TX32129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist