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MA DAIYAN IBRAHIM RPH
>> Pharmacist >> Pharmacy Service ProvidersRegistrant NPI Number: 1043300916
Individual Registrant: MA DAIYAN IBRAHIM RPH
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
1951 W HICKPOCHEE AVE LABELLE, FL 33935-4792 US
Tel: 863-302-6009 Fax: 863-302-6008
Tel: 863-302-6009 Fax: 863-302-6008
Contact information for business:
11508 CENTAUR WAY LEHIGH ACRES, FL 33971-3768 US
Tel: 239-645-8438 Fax: --
Tel: 239-645-8438 Fax: --
Registration Information:
NPI: 1043300916
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 183500000X | Pharmacy Service Providers Pharmacist | FL | PS38855 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 106506801 | FL | 05 |
