MEDICARE: GEORGE IBRAHIM

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
1	183500000X	Pharmacist	03328603	OH

General Provider Information

NPI Number	:	1457659666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE IBRAHIM

Provider Business Mailing Address
First Line	:	3512 QUEEN VICTORIA CT
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-5706
Country	:	US
Telephone Number	:	937-231-8145
Fax Number	:	937-276-9704

Provider Business Practice Location Address
First Line	:	4328 N MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-5013
Country	:	US
Telephone Number	:	937-274-1530
Fax Number	:	937-276-9704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2011
Last Update Date	:	03/11/2011

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Directions to “ GEORGE IBRAHIM ” Practice Location

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