Healthcare Provider Details

I. General information

NPI: 1174076384
Provider Name (Legal Business Name): CHRISTINE M GAMBLE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

5818 DOVE RIDGE LN
HOUSTON TX
77041-4101
US

V. Phone/Fax

Practice location:
  • Phone: 281-857-0772
  • Fax:
Mailing address:
  • Phone: 281-857-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number57004
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number122542
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: