Provider Demographics
NPI:1609659598
Name:IBRAHIM, LAUREN (RPH)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2301
Mailing Address - Country:US
Mailing Address - Phone:805-426-3722
Mailing Address - Fax:805-426-3728
Practice Address - Street 1:2417 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2301
Practice Address - Country:US
Practice Address - Phone:805-426-3722
Practice Address - Fax:805-426-3728
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist