Provider Demographics
NPI:1760015754
Name:NEGRETE, GABRIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:NEGRETE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E ALLUVIAL AVE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2812
Mailing Address - Country:US
Mailing Address - Phone:559-930-7135
Mailing Address - Fax:
Practice Address - Street 1:3011 E SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6752
Practice Address - Country:US
Practice Address - Phone:550-224-2965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist