Provider Demographics
NPI:1104300441
Name:RAGLAND, GENEVIEVE IBISI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:IBISI
Last Name:RAGLAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:GENEVIEVE
Other - Middle Name:
Other - Last Name:IBISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:17345 SW 31ST CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5586
Mailing Address - Country:US
Mailing Address - Phone:954-430-1214
Mailing Address - Fax:
Practice Address - Street 1:1900 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2230
Practice Address - Country:US
Practice Address - Phone:954-436-5635
Practice Address - Fax:954-436-6837
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPT023569183500000X
FLPS35294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS35294OtherPHARMACIST LICENSE
GARPH023569OtherPHARMACIST LICENSE