Provider Demographics
NPI:1417617358
Name:GHARIB, ELHAM (RPH)
Entity Type:Individual
Prefix:
First Name:ELHAM
Middle Name:
Last Name:GHARIB
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 1:407 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05851-5600
Mailing Address - Country:US
Mailing Address - Phone:802-626-3779
Mailing Address - Fax:802-686-1089
Practice Address - Street 1:407 BROAD ST
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851-5600
Practice Address - Country:US
Practice Address - Phone:802-626-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0134574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist