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General NPI Number Information
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NPI Number | 1457887713
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Entity Type | Individual
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Provider Name | CHRISTOPHER MICHAEL GILDEA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 60101 BODNAR BLVD STE 100B SAINT JOSEPH FAMILY MEDICINE AT ELM ROAD
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City | MISHAWAKA
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State | IN
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Zip | 46544-9340
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Country | US
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Telephone | 574-335-8500
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Fax | 574-335-0794
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Provider Business Mailing Address
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Address Line | 707 CEDAR ST STE 200 SAINT JOSEPH PHYSICIAN NETWORK
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City | SOUTH BEND
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State | IN
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Zip | 46617-2057
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Country | US
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Telephone | 574-335-8700
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Fax | 574-335-0741
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 26026231A
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License Number State | IN
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