Healthcare Provider Details

I. General information

NPI: 1649549387
Provider Name (Legal Business Name): HANY IBRAHIM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 WRIGHTSTOWN
WRIGHTSTOWN NJ
08562-1527
US

IV. Provider business mailing address

40 MANOR DR
HILLSBOROUGH NJ
08844-1422
US

V. Phone/Fax

Practice location:
  • Phone: 609-723-3176
  • Fax:
Mailing address:
  • Phone: 908-281-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03125600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: