Provider Demographics
NPI:1619208592
Name:GIMBEL, SAMANTHA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:GIMBEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3431 W UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4898
Mailing Address - Country:US
Mailing Address - Phone:602-564-6641
Mailing Address - Fax:602-564-9169
Practice Address - Street 1:3431 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4898
Practice Address - Country:US
Practice Address - Phone:602-564-6641
Practice Address - Fax:602-564-9169
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ115078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist