Provider Demographics
NPI:1679238489
Name:GAMBRELL, TYWANNA VITAL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYWANNA
Middle Name:VITAL
Last Name:GAMBRELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TYWANNA
Other - Middle Name:SHERVETTE
Other - Last Name:VITAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3202 STRATFORD POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7317
Mailing Address - Country:US
Mailing Address - Phone:281-620-8597
Mailing Address - Fax:
Practice Address - Street 1:3202 STRATFORD POINTE DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7317
Practice Address - Country:US
Practice Address - Phone:281-620-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist