Provider Demographics
NPI:1578248746
Name:GERGES, ENGY G
Entity Type:Individual
Prefix:
First Name:ENGY
Middle Name:G
Last Name:GERGES
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 1:4609 WELLESLEY CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3135
Mailing Address - Country:US
Mailing Address - Phone:727-666-1683
Mailing Address - Fax:
Practice Address - Street 1:4609 WELLESLEY CT
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3135
Practice Address - Country:US
Practice Address - Phone:727-666-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist