Healthcare Provider Details

I. General information

NPI: 1265397632
Provider Name (Legal Business Name): MRS. ROVAN SAMEH IBRAHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2287 MORRIS AVE
UNION NJ
07083-5726
US

IV. Provider business mailing address

2287 MORRIS AVE
UNION NJ
07083-5726
US

V. Phone/Fax

Practice location:
  • Phone: 908-964-6560
  • Fax:
Mailing address:
  • Phone: 908-964-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RI04473400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: