Healthcare Provider Details

I. General information

NPI: 1972407856
Provider Name (Legal Business Name): MUMINA ABDULLAHI IBRAHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8390 DELMAR BLVD
SAINT LOUIS MO
63124-2107
US

IV. Provider business mailing address

8390 DELMAR BLVD
SAINT LOUIS MO
63124-2107
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-3402
  • Fax: 314-991-8473
Mailing address:
  • Phone: 314-991-3402
  • Fax: 314-991-8473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021011310
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: