Provider Demographics
NPI:1083026801
Name:FAMILY GABLES PHARMACY INC
Entity type:Organization
Organization Name:FAMILY GABLES PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-330-0247
Mailing Address - Street 1:3401 BONITA BEACH RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4188
Mailing Address - Country:US
Mailing Address - Phone:239-330-0247
Mailing Address - Fax:239-443-4521
Practice Address - Street 1:3401 BONITA BEACH RD
Practice Address - Street 2:SUITE 405
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4188
Practice Address - Country:US
Practice Address - Phone:239-330-0247
Practice Address - Fax:239-443-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy