Provider Demographics
NPI:1730464710
Name:ABDI, UBAH IBRAHIM (RPH)
Entity Type:Individual
Prefix:MRS
First Name:UBAH
Middle Name:IBRAHIM
Last Name:ABDI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 ELDRIDGE AVE E
Mailing Address - Street 2:
Mailing Address - City:NORTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-4086
Mailing Address - Country:US
Mailing Address - Phone:651-748-8010
Mailing Address - Fax:
Practice Address - Street 1:1401 MARYLAND AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2823
Practice Address - Country:US
Practice Address - Phone:651-774-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118413-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist