Provider Demographics
NPI:1780296715
Name:IBRAHIM, ALI MAHMOOD (PHD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:MAHMOOD
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W BUSINESS 83
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5632
Mailing Address - Country:US
Mailing Address - Phone:956-447-3781
Mailing Address - Fax:956-968-9831
Practice Address - Street 1:1701 W BUSINESS 83
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5632
Practice Address - Country:US
Practice Address - Phone:956-447-3781
Practice Address - Fax:956-968-9831
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist