Provider Demographics
NPI:1942487731
Name:GAMBINO, PERRY MARTIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:MARTIN
Last Name:GAMBINO
Suffix:
Gender:M
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:PO BOX 125
Mailing Address - Street 2:15 HONEOYE COMMONS
Mailing Address - City:HONEOYE
Mailing Address - State:NY
Mailing Address - Zip Code:14471-0125
Mailing Address - Country:US
Mailing Address - Phone:585-229-2285
Mailing Address - Fax:585-229-2214
Practice Address - Street 1:15 HONEOYE COMMONS
Practice Address - Street 2:
Practice Address - City:HONEOYE
Practice Address - State:NY
Practice Address - Zip Code:14471-0125
Practice Address - Country:US
Practice Address - Phone:585-229-2285
Practice Address - Fax:585-229-2214
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036899-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist