MEDICARE: MARK MAGDY FAYEZ GARAS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS62379	FL

General Provider Information

NPI Number	:	1861064123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MAGDY FAYEZ GARAS RPH

Provider Business Mailing Address
First Line	:	8500 N WICKHAM RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-6600
Country	:	US
Telephone Number	:	321-242-6778
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 N WICKHAM RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-6600
Country	:	US
Telephone Number	:	321-242-6778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	04/05/2024

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