Provider Demographics
NPI:1114564564
Name:GABEN
Entity Type:Organization
Organization Name:GABEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEGMIA
Authorized Official - Middle Name:KENNA
Authorized Official - Last Name:TOHNYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:919-295-1112
Mailing Address - Street 1:6602 KNIGHTDALE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6567
Mailing Address - Country:US
Mailing Address - Phone:919-295-1112
Mailing Address - Fax:919-295-1164
Practice Address - Street 1:6602 KNIGHTDALE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6567
Practice Address - Country:US
Practice Address - Phone:919-295-1112
Practice Address - Fax:919-295-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy