Healthcare Provider Details

I. General information

NPI: 1578171278
Provider Name (Legal Business Name): TINA LOUISE GELLMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2020
Last Update Date: 07/19/2020
Certification Date: 07/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 NE 40TH ST
FORT LAUDERDALE FL
33308-5829
US

IV. Provider business mailing address

3011 NE 40TH ST
FORT LAUDERDALE FL
33308-5829
US

V. Phone/Fax

Practice location:
  • Phone: 410-963-3818
  • Fax:
Mailing address:
  • Phone: 410-963-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS48745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: