Provider Demographics
NPI:1386036465
Name:GAMBINA, LOUIS CHARLES (RPH)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:CHARLES
Last Name:GAMBINA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 HIGHWAY 11 S
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-5382
Mailing Address - Country:US
Mailing Address - Phone:601-798-4771
Mailing Address - Fax:601-798-6130
Practice Address - Street 1:801 HIGHWAY 11 S
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-5382
Practice Address - Country:US
Practice Address - Phone:601-798-4771
Practice Address - Fax:601-798-6130
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-12822183500000X
LA011145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist