Healthcare Provider Details

I. General information

NPI: 1588075766
Provider Name (Legal Business Name): MAGAN GILL PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7157 E SAGINAW ST EAST LANSING
EAST LANSING MI
48823-9627
US

IV. Provider business mailing address

6019 MARIETTA WAY
EAST LANSING MI
48823-9227
US

V. Phone/Fax

Practice location:
  • Phone: 517-885-9010
  • Fax:
Mailing address:
  • Phone: 517-885-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302033106
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: