Provider Demographics
NPI:1982987541
Name:GAMBLE, THOMAS ARTHUR (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ARTHUR
Last Name:GAMBLE
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 1:5435 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1746
Mailing Address - Country:US
Mailing Address - Phone:260-482-1653
Mailing Address - Fax:260-484-3783
Practice Address - Street 1:5435 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1746
Practice Address - Country:US
Practice Address - Phone:260-482-1653
Practice Address - Fax:260-484-3783
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist