Basic Information
| Provider Information | |||||||||
| NPI: | 1831437565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IBRAHIM | ||||||||
| FirstName: | AHMED HOSSAM | ||||||||
| MiddleName: | SAID | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24200 CHAGRIN BLVD | ||||||||
| Address2: | |||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162623988 | ||||||||
| FaxNumber: | 2167666085 | ||||||||
| Practice Location | |||||||||
| Address1: | 24200 CHAGRIN BLVD | ||||||||
| Address2: | |||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162623988 | ||||||||
| FaxNumber: | 2167666085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2013 | ||||||||
| LastUpdateDate: | 01/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03230652-2 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.