Provider Demographics
NPI:1124366448
Name:FABREGAS, TAMARA (RPH)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:FABREGAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2374
Mailing Address - Country:US
Mailing Address - Phone:954-557-4112
Mailing Address - Fax:
Practice Address - Street 1:19441 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-1653
Practice Address - Country:US
Practice Address - Phone:954-434-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000887795OtherPHARMACIST