Provider Demographics
NPI:1942719968
Name:PIMENTEL, GABRIELLA NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:NICOLE
Last Name:PIMENTEL
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 1:3629 DAYSTAR DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8432
Mailing Address - Country:US
Mailing Address - Phone:209-918-9676
Mailing Address - Fax:
Practice Address - Street 1:3500 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1305
Practice Address - Country:US
Practice Address - Phone:209-341-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist