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General NPI Number Information
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NPI Number | 1700401064
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Entity Type | Individual
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Provider Name | ANTHONY IBRAHIM PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 28050 GRAND RIVER AVE
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-5919
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Country | US
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Telephone | 947-521-8363
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Fax | 248-471-8498
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Provider Business Mailing Address
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Address Line | 28050 GRAND RIVER AVE
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-5919
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Country | US
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Telephone | 947-521-8363
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Fax | 248-471-8498
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 5302042501
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License Number State | MI
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