| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Tarek Mohammed Ebrahim | [sources] | |||
| Alias | Tarek Pharmacy, Inc. | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| First name | Tarek | [sources] | |||
| Last name | Ebrahim | [sources] | |||
| Middle name | Mohammed | [sources] | |||
| NPI | 1467506808 | [sources] | |||
| Registration number | 36038 · PHA218770 · PHA228700 · PHA305250 · PHA326590 · | [sources] | |||
| Sector | Pharmacy | [sources] | |||
| Address | 2550 E/ Slauson Avenue, # C, Huntington Park, CA 90255 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States · DHCS
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