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NPI Code Detail

MEDICARE: DR. JASON PATRICK GILLAM PHARMD

MEDICARE: DR. JASON PATRICK GILLAM PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P1200XPharmacotherapy PharmacistPD11058AR

General Provider Information

NPI Number : 1033483896
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON PATRICK GILLAM PHARMD
Provider Business Mailing Address
First Line : 10300 N RODNEY PARHAM RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72227-4845
Country : US
Telephone Number : 501-221-8304
Fax Number : 501-221-8303
Provider Business Practice Location Address
First Line : 10300 N RODNEY PARHAM RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72227-4845
Country : US
Telephone Number : 501-221-8304
Fax Number : 501-221-8303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2012
Last Update Date : 02/26/2012

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