NPIMap

Individual provider Active NPI

Sameh Ibrahim

  • Pharmacist
  • Myrtle Beach, SC
National Provider Identifier
1427220607
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
28RI02667400 Issued in NJ
Practice address
824 Waterton Ave
Myrtle Beach, SC 29579-5125
Phone
(843) 446-0390
NPI assigned
Mar 28, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 28RI02667400 NJ Primary

Addresses

Primary practice location

824 Waterton Ave
Myrtle Beach, SC 29579-5125

Mailing address

824 Waterton Ave
Myrtle Beach, SC 29579-5125
Phone (843) 742-5243

Other identifiers 1

IdentifierTypeStateIssuer
28RI02667400OtherNJPHARMACIST LICENSE

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

LicenseStateTypeSpecialty
28RI02667400NJMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Health Pharmacy LLC Current Accepting new patients
Health and Wellness Pharmacy LLC PastSince Dec 16, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1427220607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 WATERTON AVE",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295795125",
            "telephone_number": "843-742-5243",
            "fax_number": "843-584-8534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 WATERTON AVE",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295795125",
            "telephone_number": "843-446-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "SAMEH",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-28",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NJ",
            "license": "28RI02667400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "28RI02667400",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.

Verify at the official NPI Registry.