Provider Demographics
NPI:1790318335
Name:IMREI, GABRIELLA (RPH)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:IMREI
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 1:4808 N HOPKINS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5328
Mailing Address - Country:US
Mailing Address - Phone:414-462-4310
Mailing Address - Fax:414-462-3967
Practice Address - Street 1:4808 N HOPKINS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5328
Practice Address - Country:US
Practice Address - Phone:414-462-4310
Practice Address - Fax:414-462-3967
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19159-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist