Provider Demographics
NPI:1043068539
Name:IBRAHIM, MARINETTE (RPH, BPHARM, CPH)
Entity type:Individual
Prefix:
First Name:MARINETTE
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:RPH, BPHARM, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 TAHOE CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6630 ORION DR STE 326
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4439
Practice Address - Country:US
Practice Address - Phone:239-343-1076
Practice Address - Fax:239-343-4269
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist