Provider Demographics
NPI:1790068385
Name:GHABRAS, DIMETRY (RPH)
Entity Type:Individual
Prefix:
First Name:DIMETRY
Middle Name:
Last Name:GHABRAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6925
Mailing Address - Country:US
Mailing Address - Phone:386-761-5578
Mailing Address - Fax:
Practice Address - Street 1:1625 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6925
Practice Address - Country:US
Practice Address - Phone:386-761-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist