MEDICARE: DR. IBRAHIM ALI FARHAT RPH

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	036310-01	NY

General Provider Information

NPI Number	:	1699413559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IBRAHIM ALI FARHAT RPH

Provider Business Mailing Address
First Line	:	1109 CONEY ISLAND AVE THE MEDICINE SHOPPE PHARMACY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230
Country	:	US
Telephone Number	:	718-434-4649
Fax Number	:	718-434-4168

Provider Business Practice Location Address
First Line	:	1109 CONEY ISLAND AVE THE MEDICINE SHOPPE PHARMACY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230
Country	:	US
Telephone Number	:	718-434-4649
Fax Number	:	718-434-4168

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

Provider Enumeration Date	:	05/21/2022
Last Update Date	:	05/31/2024

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