Provider Demographics
NPI:1689284077
Name:ALI, KAREEM EBRAHIM (RPH)
Entity Type:Individual
Prefix:
First Name:KAREEM
Middle Name:EBRAHIM
Last Name:ALI
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 1:581 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2737
Mailing Address - Country:US
Mailing Address - Phone:201-991-3456
Mailing Address - Fax:201-991-1319
Practice Address - Street 1:581 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2737
Practice Address - Country:US
Practice Address - Phone:201-991-3454
Practice Address - Fax:201-991-1319
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04089100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist