Healthcare Provider Details

I. General information

NPI: 1700276730
Provider Name (Legal Business Name): THERESA GILBERT PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA VIVIAN MILLER

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST
COLORADO SPRINGS CO
80914-1541
US

IV. Provider business mailing address

559 VINCENT ST
COLORADO SPRINGS CO
80914-1541
US

V. Phone/Fax

Practice location:
  • Phone: 719-556-1166
  • Fax:
Mailing address:
  • Phone: 719-556-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number14960
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: