Provider Demographics
NPI:1861064123
Name:GARAS, MARK MAGDY FAYEZ (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:MAGDY FAYEZ
Last Name:GARAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6600
Mailing Address - Country:US
Mailing Address - Phone:321-242-6778
Mailing Address - Fax:
Practice Address - Street 1:8500 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6600
Practice Address - Country:US
Practice Address - Phone:321-242-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist