Provider Demographics
NPI:1760043137
Name:ALKASRAWI, EBA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:EBA
Middle Name:
Last Name:ALKASRAWI
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 1:1185 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1810
Mailing Address - Country:US
Mailing Address - Phone:718-484-9100
Mailing Address - Fax:
Practice Address - Street 1:2539 W 15TH ST APT C1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6973
Practice Address - Country:US
Practice Address - Phone:929-351-9614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065357-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00000Medicaid