Healthcare Provider Details

I. General information

NPI: 1548354954
Provider Name (Legal Business Name): GELSTHORPES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400A W CARPENTER ST
JERSEYVILLE IL
62052-2522
US

IV. Provider business mailing address

400A W CARPENTER ST
JERSEYVILLE IL
62052-2522
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-6461
  • Fax: 618-639-9450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054009841
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CINDY GELSTHORPE
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 618-498-6461