Healthcare Provider Details

I. General information

NPI: 1750659553
Provider Name (Legal Business Name): SANDRA L GILL SANDRA GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA L KANE-GILL SANDRA GILL

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 SALK HALL 3501 TERRACE ST
PITTSBURGH PA
15261-1909
US

IV. Provider business mailing address

918 SALK HALL 3501 TERRACE ST
PITTSBURGH PA
15261-1909
US

V. Phone/Fax

Practice location:
  • Phone: 412-624-5150
  • Fax: 412-624-1850
Mailing address:
  • Phone: 412-624-5150
  • Fax: 412-624-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP438392
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302029730
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: