Provider Demographics
NPI:1891036331
Name:GAMBREL, TRUDY (RPH)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:GAMBREL
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 1:43480 YUKON DR
Mailing Address - Street 2:KAISER PERMANENTE PHARMACY
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6988
Mailing Address - Country:US
Mailing Address - Phone:571-252-6050
Mailing Address - Fax:
Practice Address - Street 1:43480 YUKON DR
Practice Address - Street 2:KAISER PERMANENTE PHARMACY
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6988
Practice Address - Country:US
Practice Address - Phone:571-252-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist