Healthcare Provider Details

I. General information

NPI: 1831697150
Provider Name (Legal Business Name): JACQUELINE GELLATLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 N DIERS AVE
GRAND ISLAND NE
68803-1258
US

IV. Provider business mailing address

2250 N DIERS AVE
GRAND ISLAND NE
68803-1258
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-0337
  • Fax: 308-381-0322
Mailing address:
  • Phone: 308-381-0337
  • Fax: 308-381-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11162
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: