Provider Demographics
NPI:1821180589
Name:GAMBLE, RACHEL F (PD)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:F
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:PD
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:KATHRYN
Other - Last Name:FAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10509 OAKLINE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-505-9038
Mailing Address - Fax:
Practice Address - Street 1:15128 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-7307
Practice Address - Country:US
Practice Address - Phone:225-751-4415
Practice Address - Fax:225-751-0429
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1267783Medicaid