Provider Demographics
NPI:1346844602
Name:IODICE, GABRIELLE NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:NICOLE
Last Name:IODICE
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 1:640 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1106
Mailing Address - Country:US
Mailing Address - Phone:719-948-5200
Mailing Address - Fax:
Practice Address - Street 1:640 ARTHUR KILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1106
Practice Address - Country:US
Practice Address - Phone:718-948-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770686511OtherPHARMACY