Provider Demographics
NPI:1972165488
Name:ALSIBAI, RAZAN (RPH)
Entity Type:Individual
Prefix:
First Name:RAZAN
Middle Name:
Last Name:ALSIBAI
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 1:3118 W LAKE ST UNIT 228
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-6807
Mailing Address - Country:US
Mailing Address - Phone:952-567-0245
Mailing Address - Fax:
Practice Address - Street 1:851 MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1548
Practice Address - Country:US
Practice Address - Phone:952-442-4407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist