Provider Demographics
NPI:1578163192
Name:IBRAHIM, GHADA ABDULGHANI
Entity Type:Individual
Prefix:
First Name:GHADA
Middle Name:ABDULGHANI
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 1:4712 ROCKCREEK LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2440
Mailing Address - Country:US
Mailing Address - Phone:214-215-0350
Mailing Address - Fax:
Practice Address - Street 1:160 N COIT RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5454
Practice Address - Country:US
Practice Address - Phone:972-497-9339
Practice Address - Fax:972-497-9389
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist