Provider Demographics
NPI:1912188509
Name:GAMBINO, DENISE MAHONEY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MAHONEY
Last Name:GAMBINO
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 1:2660 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9349
Mailing Address - Country:US
Mailing Address - Phone:585-334-2721
Mailing Address - Fax:585-334-6151
Practice Address - Street 1:2660 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9349
Practice Address - Country:US
Practice Address - Phone:585-334-2721
Practice Address - Fax:585-334-6151
Is Sole Proprietor?:No
Enumeration Date:2007-11-25
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00446882Medicaid