Provider Demographics
NPI:1912658675
Name:NAM, GABRIELLE C (PHARMD)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:C
Last Name:NAM
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 1:9006 GUILBEAU RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-2652
Mailing Address - Country:US
Mailing Address - Phone:210-536-3158
Mailing Address - Fax:
Practice Address - Street 1:9006 GUILBEAU RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-2652
Practice Address - Country:US
Practice Address - Phone:210-536-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47953183500000X
PARP455340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist