Healthcare Provider Details

I. General information

NPI: 1174166326
Provider Name (Legal Business Name): JOEL ROSS GILLMEISTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 86 AND TOPAWA RD
SELLS AZ
85634
US

IV. Provider business mailing address

POX 548
SELLS AZ
85634
US

V. Phone/Fax

Practice location:
  • Phone: 520-383-7350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42340
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: