Healthcare Provider Details

I. General information

NPI: 1841638160
Provider Name (Legal Business Name): IBRAM ATALLA PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2013
Last Update Date: 06/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 MAIN ST
EAST ORANGE NJ
07018-2207
US

IV. Provider business mailing address

730 NEWARK AVE APT 4D
JERSEY CITY NJ
07306-2818
US

V. Phone/Fax

Practice location:
  • Phone: 973-672-6317
  • Fax:
Mailing address:
  • Phone: 201-780-0976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03524800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: