Individual
DR. GERALD JASON IBRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
4768 SHORE DR, VIRGINIA BEACH, VA 23455-2713
(757) 460-1290
(757) 460-1547
Mailing address
4812 LEE AVE, VIRGINIA BEACH, VA 23455-1334
(757) 460-1290
(757) 460-1547
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202205624
VA
183500000X
Pharmacist
14138
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202205624
VIRGINIA PHARMACY LICENSE NUMBER
VA
Enumeration date
09/12/2011
Last updated
09/12/2011
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