Provider Demographics
NPI:1972808889
Name:GAMBLE, JEJUAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JEJUAN
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4147 SUNSET RDG
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0224
Mailing Address - Country:US
Mailing Address - Phone:704-962-9136
Mailing Address - Fax:
Practice Address - Street 1:592 LANCASTER HWY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-1658
Practice Address - Country:US
Practice Address - Phone:704-962-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist