Ma Daiyan Ibrahim, RPH
Individual provider Active NPI Pharmacist · Labelle, FL
NPI 1043300916 · NPPES record last updated Sep 23, 2016
Key facts
- NPI
- 1043300916
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS38855 (FL)
- Practice address
- 1951 W Hickpochee Ave
Labelle, FL 33935-4792 - Phone
- (863) 302-6009
- Fax
- (863) 302-6008
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS38855 | FL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS38855 | FL | Yes |
Addresses
Primary practice location
1951 W Hickpochee Ave
Labelle, FL 33935-4792
Mailing address
11508 Centaur Way
Lehigh Acres, FL 33971-3768
Phone (239) 645-8438
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106506801 | Medicaid | FL |
Other names
- Mohammad Abdud Daiyan
Other providers in Labelle, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.