Provider Demographics
NPI:1003576745
Name:REMBERT, SERABI
Entity Type:Individual
Prefix:
First Name:SERABI
Middle Name:
Last Name:REMBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 BEAVER RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-3714
Mailing Address - Country:US
Mailing Address - Phone:786-512-5827
Mailing Address - Fax:
Practice Address - Street 1:6950 BEAVER RUN RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820
Practice Address - Country:US
Practice Address - Phone:706-563-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist