Provider Demographics
NPI:1649557885
Name:GABRIEL, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 EAST SHORE HWY
Mailing Address - Street 2:TARGET T-1926
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94710
Mailing Address - Country:US
Mailing Address - Phone:510-982-0512
Mailing Address - Fax:
Practice Address - Street 1:1057 EAST SHORE HWY
Practice Address - Street 2:TARGET T-1926
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94710
Practice Address - Country:US
Practice Address - Phone:510-982-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist