MEDICARE: CAMERINA N GAMBOA-ETTEL PHARMD

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	16995	NV

General Provider Information

NPI Number	:	1285175505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERINA N GAMBOA-ETTEL PHARMD

Provider Business Mailing Address
First Line	:	4433 SHOEN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3325
Country	:	US
Telephone Number	:	702-340-5240
Fax Number	:

Provider Business Practice Location Address
First Line	:	2870 S MARYLAND PKWY STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-1548
Country	:	US
Telephone Number	:	702-558-2382
Fax Number	:	702-558-5407

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

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	03/20/2017

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Directions to “ CAMERINA N GAMBOA-ETTEL PHARMD” Practice Location

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