Healthcare Provider Details

I. General information

NPI: 1730469917
Provider Name (Legal Business Name): AMY MARIE GABRIEL PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WINDERMERE AVE
GREENWOOD LAKE NY
10925-3099
US

IV. Provider business mailing address

123 WINDERMERE AVE PO BOX 1837
GREENWOOD LAKE NY
10925-3099
US

V. Phone/Fax

Practice location:
  • Phone: 845-477-8024
  • Fax:
Mailing address:
  • Phone: 845-477-8024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number055937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: