Provider Demographics
NPI:1396535712
Name:GIRGIS, MARINA THARWAT (MTG)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:THARWAT
Last Name:GIRGIS
Suffix:
Gender:F
Credentials:MTG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12934 PAYTON ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2717
Mailing Address - Country:US
Mailing Address - Phone:615-243-5418
Mailing Address - Fax:
Practice Address - Street 1:12934 PAYTON ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2717
Practice Address - Country:US
Practice Address - Phone:615-243-5418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist