Provider Demographics
NPI:1225757115
Name:JOHANNESSEN, GABRIELLE RATON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:RATON
Last Name:JOHANNESSEN
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 1:2527 ALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3401
Mailing Address - Country:US
Mailing Address - Phone:407-678-5151
Mailing Address - Fax:
Practice Address - Street 1:839 N ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2921
Practice Address - Country:US
Practice Address - Phone:407-647-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist