Provider Demographics
NPI:1659592418
Name:IBRAHIM, KHADIJAT OLUWAWEMIMO (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:KHADIJAT
Middle Name:OLUWAWEMIMO
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MISS
Other - First Name:KHADIJAT
Other - Middle Name:
Other - Last Name:LAWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BPHARM
Mailing Address - Street 1:9711 BYWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1871
Mailing Address - Country:US
Mailing Address - Phone:240-432-3772
Mailing Address - Fax:
Practice Address - Street 1:1501 DIVISION ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3121
Practice Address - Country:US
Practice Address - Phone:410-383-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X
MD19414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician