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NPI Code Detail

MEDICARE: MRS. SUSAN GAIL GILLIS

MEDICARE: MRS. SUSAN GAIL GILLIS
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
1183500000XPharmacist36407TX

General Provider Information

NPI Number : 1205163813
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN GAIL GILLIS
Provider Business Mailing Address
First Line : 1701 9TH ST
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76301-5002
Country : US
Telephone Number : 940-723-7979
Fax Number :
Provider Business Practice Location Address
First Line : 1701 9TH ST
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76301-5002
Country : US
Telephone Number : 940-723-7979
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2009
Last Update Date : 11/04/2009

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Directions to “ MRS. SUSAN GAIL GILLIS ” Practice Location

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