Provider Demographics
NPI:1780418004
Name:GHRAYEB, ATHEEL
Entity type:Individual
Prefix:
First Name:ATHEEL
Middle Name:
Last Name:GHRAYEB
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 1:8511 BUCKHURST RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5169
Mailing Address - Country:US
Mailing Address - Phone:901-413-0094
Mailing Address - Fax:
Practice Address - Street 1:8511 BUCKHURST RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5169
Practice Address - Country:US
Practice Address - Phone:901-413-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist