Healthcare Provider Details

I. General information

NPI: 1114579216
Provider Name (Legal Business Name): HABIBA IQBAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6433 RISING SUN AVE
PHILADELPHIA PA
19111-5228
US

IV. Provider business mailing address

6433 RISING SUN AVE
PHILADELPHIA PA
19111-5228
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-0202
  • Fax:
Mailing address:
  • Phone: 215-745-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP453355
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: