Provider Demographics
NPI:1770501348
Name:SABRA, AHMED M
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:M
Last Name:SABRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 MALCOLM X BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1806
Mailing Address - Country:US
Mailing Address - Phone:212-283-2136
Mailing Address - Fax:212-283-2463
Practice Address - Street 1:543 MALCOLM X BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1806
Practice Address - Country:US
Practice Address - Phone:212-283-2136
Practice Address - Fax:212-283-2463
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist