Provider Demographics
NPI:1427366608
Name:GAMBLE, BRIAN S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-2392
Mailing Address - Country:US
Mailing Address - Phone:704-466-7172
Mailing Address - Fax:
Practice Address - Street 1:404 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4910
Practice Address - Country:US
Practice Address - Phone:910-484-1106
Practice Address - Fax:910-484-1969
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist