Provider Demographics
NPI:1487384384
Name:IBSS CORP
Entity type:Organization
Organization Name:IBSS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAFA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:301-675-8740
Mailing Address - Street 1:1110 BONIFANT ST STE 501
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3358
Mailing Address - Country:US
Mailing Address - Phone:301-675-8740
Mailing Address - Fax:
Practice Address - Street 1:1110 BONIFANT ST STE 501
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3358
Practice Address - Country:US
Practice Address - Phone:301-675-8740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy