Provider Demographics
NPI:1609476688
Name:BARIAGABR, HERMON HABTOM (PHARM D)
Entity Type:Individual
Prefix:
First Name:HERMON
Middle Name:HABTOM
Last Name:BARIAGABR
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 S FORT APACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1722
Mailing Address - Country:US
Mailing Address - Phone:702-367-1003
Mailing Address - Fax:
Practice Address - Street 1:5200 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1722
Practice Address - Country:US
Practice Address - Phone:702-367-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist