MEDICARE: DR. DANNELL GILLESPIE 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	RPH030025	GA

General Provider Information

NPI Number	:	1336641687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANNELL GILLESPIE PHARMD

Provider Business Mailing Address
First Line	:	10 PERIMETER PARK DR APT 528
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1349
Country	:	US
Telephone Number	:	314-724-6886
Fax Number	:

Provider Business Practice Location Address
First Line	:	2955 ATLANTA RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-3654
Country	:	US
Telephone Number	:	770-319-1127
Fax Number	:

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

Provider Enumeration Date	:	03/02/2018
Last Update Date	:	03/02/2018

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