Provider Demographics
NPI:1588830293
Name:GAMBLE, EMMETTE THOMAS JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:EMMETTE
Middle Name:THOMAS
Last Name:GAMBLE
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:EMMETTE
Other - Middle Name:T
Other - Last Name:GAMBLE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3639 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5623
Mailing Address - Country:US
Mailing Address - Phone:561-968-4867
Mailing Address - Fax:
Practice Address - Street 1:4624 HYPOLUXO ROAD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463
Practice Address - Country:US
Practice Address - Phone:561-694-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist