Provider Demographics
NPI:1699123992
Name:FARAG, GEORGINA (PHARMD, CPH)
Entity type:Individual
Prefix:DR
First Name:GEORGINA
Middle Name:
Last Name:FARAG
Suffix:
Gender:F
Credentials:PHARMD, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 LANTERNBACK ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4708
Mailing Address - Country:US
Mailing Address - Phone:407-790-5246
Mailing Address - Fax:
Practice Address - Street 1:6450 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5747
Practice Address - Country:US
Practice Address - Phone:321-409-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS512081835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care