Provider Demographics
NPI:1689270860
Name:GAMBRALL, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GAMBRALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 WOODCREST CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8468
Mailing Address - Country:US
Mailing Address - Phone:812-480-2077
Mailing Address - Fax:
Practice Address - Street 1:6633 WOODCREST CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8468
Practice Address - Country:US
Practice Address - Phone:812-480-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist