Healthcare Provider Details

I. General information

NPI: 1043864614
Provider Name (Legal Business Name): CARLY TAMAR GABRIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9805 MCKNIGHT RD
PITTSBURGH PA
15237-6008
US

IV. Provider business mailing address

3501 TERRACE ST
PITTSBURGH PA
15213-2523
US

V. Phone/Fax

Practice location:
  • Phone: 412-366-3214
  • Fax:
Mailing address:
  • Phone: 412-624-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP453375
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: