Healthcare Provider Details

I. General information

NPI: 1396058848
Provider Name (Legal Business Name): DR. SUZANNE R GAMBALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WILTON RD
PETERBOROUGH NH
03458-1799
US

IV. Provider business mailing address

11 KEARNS DR
MERRIMACK NH
03054-3112
US

V. Phone/Fax

Practice location:
  • Phone: 603-924-3632
  • Fax:
Mailing address:
  • Phone: 603-568-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3700
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: