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General NPI Number Information
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NPI Number | 1790062453
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Entity Type | Individual
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Provider Name | SAM IBRAHIM PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 9 COMMERCE DR
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City | SCHAUMBURG
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State | IL
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Zip | 60173-5302
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Country | US
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Telephone | 855-237-9112
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Fax | 855-237-9113
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Provider Business Mailing Address
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Address Line | 9 COMMERCE DR
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City | SCHAUMBURG
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State | IL
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Zip | 60173-5302
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Country | US
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Telephone | 855-237-9112
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Fax | 855-237-9113
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 262024319A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 227715
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0017790
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP0011563
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License Number State | WV
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Taxonomy #5
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051294886
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License Number State | IL
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