MEDICARE: GILL DRUG CO. INC.

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	3336C0003X	Community/Retail Pharmacy	PHRE004458	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689734253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILL DRUG CO. INC.

Provider Business Mailing Address
First Line	:	PO BOX 46
Second Line	:	54 EAST OGLETHORPE STREET
City	:	ELLAVILLE
State	:	GA
Zip	:	31806-0046
Country	:	US
Telephone Number	:	229-937-2002
Fax Number	:	229-937-5060

Provider Business Practice Location Address
First Line	:	54 EAST OGLETHORPE STREET
Second Line	:
City	:	ELLAVILLE
State	:	GA
Zip	:	31806
Country	:	US
Telephone Number	:	229-937-2002
Fax Number	:	229-937-5060

Authorized Official
Title or Position	:	CEO
Name	:	MRS. PAULA GILL WILLIAMS
Credential	:	RPH
Telephone Number	:	229-937-2002

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/17/2013

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Directions to “GILL DRUG CO. INC. ” Practice Location

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