Provider Demographics
NPI:1356116941
Name:NAHRA YAZBECK, GIZELLE
Entity type:Individual
Prefix:
First Name:GIZELLE
Middle Name:
Last Name:NAHRA YAZBECK
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 1:149 OAKLAND ST BLDG D1
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1797
Mailing Address - Country:US
Mailing Address - Phone:508-345-4268
Mailing Address - Fax:
Practice Address - Street 1:149 OAKLAND ST BLDG D1
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1797
Practice Address - Country:US
Practice Address - Phone:508-345-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH997035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist