MEDICARE: KIMBERLY GILLESPIE

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
1	183500000X	Pharmacist	051295294	IL

General Provider Information

NPI Number	:	1124504923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY GILLESPIE

Provider Business Mailing Address
First Line	:	1000 GRASSLAND CT
Second Line	:
City	:	SHILOH
State	:	IL
Zip	:	62221-3549
Country	:	US
Telephone Number	:	618-972-2520
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 CAMP JACKSON RD
Second Line	:
City	:	CAHOKIA
State	:	IL
Zip	:	62206-2539
Country	:	US
Telephone Number	:	618-332-0676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2018
Last Update Date	:	07/14/2018

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Directions to “ KIMBERLY GILLESPIE ” Practice Location

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