Provider Demographics
NPI:1386248896
Name:GHOBRIAL, MARTINA
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:GHOBRIAL
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 1:17 HARVEST RD
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569-1424
Mailing Address - Country:US
Mailing Address - Phone:774-210-2616
Mailing Address - Fax:
Practice Address - Street 1:199 GREAT RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2713
Practice Address - Country:US
Practice Address - Phone:782-275-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist