Provider Demographics
NPI:1659976553
Name:EBRAHIM, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:EBRAHIM
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 1:5748 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5302
Mailing Address - Country:US
Mailing Address - Phone:305-661-5650
Mailing Address - Fax:305-661-5651
Practice Address - Street 1:5748 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5302
Practice Address - Country:US
Practice Address - Phone:305-661-5650
Practice Address - Fax:305-661-5651
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist