Provider Demographics
NPI:1457231292
Name:AGRABA, MHAI NANG (PHARMD)
Entity type:Individual
Prefix:
First Name:MHAI
Middle Name:NANG
Last Name:AGRABA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12903 LUDO RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2622
Mailing Address - Country:US
Mailing Address - Phone:904-614-8404
Mailing Address - Fax:
Practice Address - Street 1:1700 RIDGEWOOD AVE STE J
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-1782
Practice Address - Country:US
Practice Address - Phone:888-791-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI43795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty