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MA DAIYAN IBRAHIM RPH

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1043300916

Individual Registrant:
 MA DAIYAN IBRAHIM RPH
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

Contact information for business:
11508 CENTAUR WAY  LEHIGH ACRES, FL 33971-3768 US
Tel: 239-645-8438  Fax: --

Registration Information:
NPI: 1043300916
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
FLPS38855

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
106506801FL05




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