Provider Demographics
NPI:1912303389
Name:BROCK, GABRIELLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:BROCK
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 1:8931 COLONIAL CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7809
Mailing Address - Country:US
Mailing Address - Phone:239-343-9523
Mailing Address - Fax:239-343-9524
Practice Address - Street 1:8931 COLONIAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7809
Practice Address - Country:US
Practice Address - Phone:239-343-9523
Practice Address - Fax:239-343-9524
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS296621835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology