Provider Demographics
NPI:1013790849
Name:GHARGHORY, KARMEN
Entity type:Individual
Prefix:
First Name:KARMEN
Middle Name:
Last Name:GHARGHORY
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 1:10294 CAROLINA WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8803
Mailing Address - Country:US
Mailing Address - Phone:239-634-7427
Mailing Address - Fax:
Practice Address - Street 1:16000 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:N FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-2107
Practice Address - Country:US
Practice Address - Phone:239-656-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist