Provider Demographics
NPI:1881004760
Name:LAMB, GLORIA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:MARIE
Last Name:LAMB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 CLARKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-3771
Mailing Address - Country:US
Mailing Address - Phone:951-314-6062
Mailing Address - Fax:
Practice Address - Street 1:2350 CLARKE DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-3771
Practice Address - Country:US
Practice Address - Phone:951-314-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016460183500000X
CA45905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist