1669120697 NPI number — MR. ERIC A GAMBARO PHARMACY TECHNICIAN

Table of content: MR. ERIC A GAMBARO PHARMACY TECHNICIAN (NPI 1669120697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669120697 NPI number — MR. ERIC A GAMBARO PHARMACY TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAMBARO
Provider First Name:
ERIC
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACY TECHNICIAN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669120697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5647 BLUE HARBOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34653-4402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-255-1969
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5647 BLUE HARBOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34653-4402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
172-725-5196
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  RPT41392 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RPT41392 . This is a "FLORIDA DEPT OF HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".