Provider Demographics
NPI:1073156766
Name:GHOBRIAL, ZAKI WADIE ZAKI
Entity Type:Individual
Prefix:
First Name:ZAKI
Middle Name:WADIE ZAKI
Last Name:GHOBRIAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14461 SAINT GERMAIN DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2225
Mailing Address - Country:US
Mailing Address - Phone:703-687-7693
Mailing Address - Fax:
Practice Address - Street 1:33 MEADOW LN UNIT 7
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3807
Practice Address - Country:US
Practice Address - Phone:681-247-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0010271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist