Provider Demographics
NPI:1952884678
Name:GUIRGUIS, IBRAHIM A
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:A
Last Name:GUIRGUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BUENA VISTA RD STE A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9731
Mailing Address - Country:US
Mailing Address - Phone:661-665-9109
Mailing Address - Fax:
Practice Address - Street 1:3300 BUENA VISTA RD STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9731
Practice Address - Country:US
Practice Address - Phone:661-665-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist