Provider Demographics
NPI:1932472701
Name:GABRIEL, CONSTANCE KATHLENE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:KATHLENE
Last Name:GABRIEL
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 1:23875 129TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-9684
Mailing Address - Country:US
Mailing Address - Phone:763-428-2922
Mailing Address - Fax:
Practice Address - Street 1:5510 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2620
Practice Address - Country:US
Practice Address - Phone:800-553-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111374OtherSTATE OF MINNESOTA PHARMACY LICENSE NUMBER