Individual
FATEN IBRAHIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 S WILLOW AVE, COOKEVILLE, TN 38501-3727
(931) 525-6240
Mailing address
3357 LAKE BROOK BLVD, KNOXVILLE, TN 37909-3705
(917) 600-7818
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
46764
TN
Other
Enumeration date
05/07/2025
Last updated
05/07/2025
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