Provider Demographics
NPI:1760706550
Name:ZIBAK, JAMILEH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JAMILEH
Middle Name:
Last Name:ZIBAK
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 1:405 AVENUE M
Mailing Address - Street 2:M DRUGS INC.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 AVENUE M
Practice Address - Street 2:M DRUGS INC.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4611
Practice Address - Country:US
Practice Address - Phone:718-252-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist