Healthcare Provider Details

I. General information

NPI: 1285557629
Provider Name (Legal Business Name): OMNIA IBRAHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 MASSACHUSETTS AVE
CAMBRIDGE MA
02139-3307
US

IV. Provider business mailing address

14 FERNALD DR APT 22
CAMBRIDGE MA
02138-1432
US

V. Phone/Fax

Practice location:
  • Phone: 617-876-7868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1003609
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: