MEDICARE: GINA GAMBARDELLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS52231	FL

General Provider Information

NPI Number	:	1114520756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA GAMBARDELLA

Provider Business Mailing Address
First Line	:	9425 BOCA GARDENS PKWY APT C
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-3772
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4970 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3843
Country	:	US
Telephone Number	:	561-498-7001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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