Provider Demographics
NPI:1659652147
Name:GAMBESKI, CAROL (RPH)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:GAMBESKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 PROVIDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3945
Mailing Address - Country:US
Mailing Address - Phone:386-789-6096
Mailing Address - Fax:
Practice Address - Street 1:1925 PROVIDENCE BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3945
Practice Address - Country:US
Practice Address - Phone:386-789-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33179183500000X
NY037966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist