Provider Demographics
NPI:1316564669
Name:LAW, GABRIELLE RENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:RENE
Last Name:LAW
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 1:7000 N BALTIMORE WOODLAND LN
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:IN
Mailing Address - Zip Code:46157-9092
Mailing Address - Country:US
Mailing Address - Phone:317-460-5212
Mailing Address - Fax:
Practice Address - Street 1:7120 CLEARVISTA DR STE 1900
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1569
Practice Address - Country:US
Practice Address - Phone:317-567-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028788A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist