Provider Demographics
NPI:1386926806
Name:GEMBALA, KELLY D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:D
Last Name:GEMBALA
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 1:3141 TREMONT RD
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2021
Mailing Address - Country:US
Mailing Address - Phone:614-538-0029
Mailing Address - Fax:
Practice Address - Street 1:3141 TREMONT RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-2021
Practice Address - Country:US
Practice Address - Phone:614-538-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129487-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist