MEDICARE: MR. SHERIF IBRAHIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835X0200X	Oncology Pharmacist	PH235180	MA

General Provider Information

NPI Number	:	1346800182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHERIF IBRAHIM

Provider Business Mailing Address
First Line	:	200 SHERMAN RD
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-3180
Country	:	US
Telephone Number	:	857-241-0576
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 BEAR HILL ROAD
Second Line	:	ONCO360 ONCOLOGY PHARMACY
City	:	WALTHAM
State	:	MA
Zip	:	02451-0245
Country	:	US
Telephone Number	:	877-662-6633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	06/14/2019

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