Healthcare Provider Details

I. General information

NPI: 1629785449
Provider Name (Legal Business Name): ROSANNA MARIA GAMBINO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 SEQUOIA DR
AURORA IL
60506-6209
US

IV. Provider business mailing address

708 BLOSSOM CT
OSWEGO IL
60543-8271
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-6824
  • Fax:
Mailing address:
  • Phone: 630-551-6123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number051304774
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: