Provider Demographics
NPI:1184982845
Name:EL-ZOGHBI, CHARLY
Entity type:Individual
Prefix:
First Name:CHARLY
Middle Name:
Last Name:EL-ZOGHBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-1701
Mailing Address - Country:US
Mailing Address - Phone:508-335-9177
Mailing Address - Fax:
Practice Address - Street 1:25 PARK ST
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-1701
Practice Address - Country:US
Practice Address - Phone:508-335-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist