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General NPI Number Information
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NPI Number | 1386248896
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Entity Type | Individual
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Provider Name | MARTINA GHOBRIAL
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Gender | Female
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 199 GREAT RD
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City | BEDFORD
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State | MA
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Zip | 01730-2713
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Country | US
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Telephone | 782-275-3607
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Fax |
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Provider Business Mailing Address
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Address Line | 17 HARVEST RD
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City | UXBRIDGE
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State | MA
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Zip | 01569-1424
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Country | US
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Telephone | 774-210-2616
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH239867
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License Number State | MA
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