Healthcare Provider Details

I. General information

NPI: 1346800182
Provider Name (Legal Business Name): MR. SHERIF IBRAHIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BEAR HILL ROAD ONCO360 ONCOLOGY PHARMACY
WALTHAM MA
02451-0245
US

IV. Provider business mailing address

200 SHERMAN RD
CHESTNUT HILL MA
02467-3180
US

V. Phone/Fax

Practice location:
  • Phone: 877-662-6633
  • Fax:
Mailing address:
  • Phone: 857-241-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPH235180
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: