Active NPI
Evon Ibrahim
- Pharmacist
- Sterling Heights, MI
National Provider Identifier
1922721620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5351016299
- Practice address
- 15142 Hall Rd
Sterling Heights, MI 48313-1236 - Phone
- (586) 247-5610
- NPI assigned
- Sep 19, 2022
- 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 | 5351016299 | MI | Primary |
Addresses
Primary practice location
15142 Hall Rd
Sterling Heights, MI 48313-1236
Mailing address
15142 Hall Rd
Sterling Heights, MI 48313-1236
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 |
|---|---|---|---|
| 5351016299 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodward Detroit CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
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": "1663545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663545600000",
"number": "1922721620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15142 HALL RD",
"city": "STERLING HEIGHTS",
"state": "MI",
"postal_code": "483131236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15142 HALL RD",
"city": "STERLING HEIGHTS",
"state": "MI",
"postal_code": "483131236",
"telephone_number": "586-247-5610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "EVON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-19",
"last_updated": "2022-09-19",
"certification_date": "2022-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5351016299",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sterling Heights, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.