Provider Demographics
NPI:1427797950
Name:GHOBRIAL, MIRETTE SAMIR RAMZI
Entity type:Individual
Prefix:
First Name:MIRETTE
Middle Name:SAMIR RAMZI
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 1:21463 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2108
Mailing Address - Country:US
Mailing Address - Phone:510-538-2745
Mailing Address - Fax:
Practice Address - Street 1:21463 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2108
Practice Address - Country:US
Practice Address - Phone:510-538-2745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist