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General NPI Number Information
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NPI Number | 1134316508
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Entity Type | Individual
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Provider Name | SERITHA CAROL GILBERT RPH
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Gender | Female
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 655 7TH ST BLDG 700700-A 78 MDG/SGHC-CREDENTIALS
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City | ROBINS AFB
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State | GA
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Zip | 31098-2227
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Country | US
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Telephone | 478-287-6112
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Fax |
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Provider Business Mailing Address
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Address Line | 221 MOUNT ZION RD
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City | BONAIRE
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State | GA
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Zip | 31005-4426
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Country | US
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Telephone | 478-287-6112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 007731
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH021435
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License Number State | GA
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