Provider Demographics
NPI:1225634371
Name:GAMBILL, LORI ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:GAMBILL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8452 W COUNTY ROAD 300 N
Mailing Address - Street 2:
Mailing Address - City:MEROM
Mailing Address - State:IN
Mailing Address - Zip Code:47861-8021
Mailing Address - Country:US
Mailing Address - Phone:812-243-5619
Mailing Address - Fax:
Practice Address - Street 1:8452 W COUNTY ROAD 300 N
Practice Address - Street 2:
Practice Address - City:MEROM
Practice Address - State:IN
Practice Address - Zip Code:47861-8021
Practice Address - Country:US
Practice Address - Phone:812-243-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015517A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist