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NPI Code Detail

MEDICARE: MS. AIDA IBAREK

MEDICARE: MS. AIDA IBAREK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist119556MN

General Provider Information

NPI Number : 1114213923
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AIDA IBAREK
Provider Business Mailing Address
First Line : 5302 KINGS XING
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1601
Country : US
Telephone Number : 617-304-9403
Fax Number :
Provider Business Practice Location Address
First Line : 7535 W BROADWAY AVE
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55428-1287
Country : US
Telephone Number : 763-425-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2011
Last Update Date : 06/21/2011

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