Active NPI
Vivian Ibrahim
- Pharmacist
- Warren, MI
National Provider Identifier
1407457609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302034136
- Practice address
- 29176 Van Dyke Ave
Warren, MI 48093-6764 - Phone
- (586) 467-0265
- Fax
- (586) 467-0259
- NPI assigned
- Nov 4, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302034136 | MI | Primary |
Addresses
Primary practice location
29176 Van Dyke Ave
Warren, MI 48093-6764
Mailing address
6331 Country Ridge Dr
Troy, MI 48098-6547
Phone (248) 854-7888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302034136 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604448000000",
"number": "1407457609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6331 COUNTRY RIDGE DR",
"city": "TROY",
"state": "MI",
"postal_code": "480986547",
"telephone_number": "248-854-7888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29176 VAN DYKE AVE",
"city": "WARREN",
"state": "MI",
"postal_code": "480936764",
"telephone_number": "586-467-0265",
"fax_number": "586-467-0259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "VIVIAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-04",
"last_updated": "2020-11-04",
"certification_date": "2020-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302034136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.