Provider Demographics
NPI:1659976405
Name:GHANEM, PAUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GHANEM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7016 BERACASA WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3447
Mailing Address - Country:US
Mailing Address - Phone:561-391-8770
Mailing Address - Fax:
Practice Address - Street 1:7016 BERACASA WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3447
Practice Address - Country:US
Practice Address - Phone:561-391-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty