Provider Demographics
NPI:1013785427
Name:ABDELWAHAB, IBRAHIM A (PHARMD)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:A
Last Name:ABDELWAHAB
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 TITAN ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2957
Mailing Address - Country:US
Mailing Address - Phone:504-881-5734
Mailing Address - Fax:
Practice Address - Street 1:2001 CAROL SUE AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-4445
Practice Address - Country:US
Practice Address - Phone:504-366-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist