Provider Demographics
NPI:1255131520
Name:IBRAHIM, YASSER (RPH)
Entity type:Individual
Prefix:
First Name:YASSER
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WESTOVER TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1613
Mailing Address - Country:US
Mailing Address - Phone:973-234-2339
Mailing Address - Fax:
Practice Address - Street 1:265 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4205
Practice Address - Country:US
Practice Address - Phone:973-243-7004
Practice Address - Fax:973-243-7884
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04422900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist