Provider Demographics
NPI:1316283047
Name:GAMBLE, YALANDER MOORE (RPH)
Entity type:Individual
Prefix:
First Name:YALANDER
Middle Name:MOORE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10128 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4384
Mailing Address - Country:US
Mailing Address - Phone:803-788-1655
Mailing Address - Fax:
Practice Address - Street 1:835 SPARKLEBERRY LANE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-2922
Practice Address - Country:US
Practice Address - Phone:803-567-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist