Provider Demographics
NPI:1508740317
Name:GAMBOA, MANUEL (PHARMD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 YOCUM RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-9245
Mailing Address - Country:US
Mailing Address - Phone:479-616-4845
Mailing Address - Fax:
Practice Address - Street 1:240 SLACK ST
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-3759
Practice Address - Country:US
Practice Address - Phone:479-451-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD17416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist