Provider Demographics
NPI:1720326283
Name:DUBAL, PRITI G (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:PRITI
Middle Name:G
Last Name:DUBAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9728 VINEYARD CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4347
Mailing Address - Country:US
Mailing Address - Phone:954-803-9282
Mailing Address - Fax:
Practice Address - Street 1:9728 VINEYARD CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4347
Practice Address - Country:US
Practice Address - Phone:954-803-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist