Provider Demographics
NPI:1457235749
Name:IBRAHIM, DINA IMAD (PHARMD)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:IMAD
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 PALISADE PARK CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6698
Mailing Address - Country:US
Mailing Address - Phone:404-488-4996
Mailing Address - Fax:
Practice Address - Street 1:35 COLLIER RD NW STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1780
Practice Address - Country:US
Practice Address - Phone:404-350-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0356871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist