Provider Demographics
NPI:1326223603
Name:MABRY, MICHAEL RAFAEL
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAFAEL
Last Name:MABRY
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 1:8901 WISCONSIN AVE
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5600
Mailing Address - Country:US
Mailing Address - Phone:301-319-4217
Mailing Address - Fax:301-295-4662
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:301-319-4217
Practice Address - Fax:301-295-4662
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020595183500000X
AL14949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist