Healthcare Provider Details

I. General information

NPI: 1326168097
Provider Name (Legal Business Name): JENNIFER LYNN GILES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 OFALLON SQ
O FALLON MO
63366-3034
US

IV. Provider business mailing address

1607 BRETT RIDGE DR
DARDENNE PRAIRIE MO
63368-7298
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-1262
  • Fax:
Mailing address:
  • Phone: 636-561-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2001019306
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: