=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629785449
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSANNA MARIA GAMBINO PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2022
-----------------------------------------------------
Last Update Date | 11/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2285 SEQUOIA DR
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506-6209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-859-6824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 708 BLOSSOM CT
-----------------------------------------------------
City | OSWEGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60543-8271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-551-6123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | 051304774
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------