MEDICARE: MR. BARRY GILLES

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	RP024937L	PA

General Provider Information

NPI Number	:	1326367319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BARRY GILLES

Provider Business Mailing Address
First Line	:	200 W RIDGE PIKE
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-3702
Country	:	US
Telephone Number	:	610-828-1274
Fax Number	:	610-828-0248

Provider Business Practice Location Address
First Line	:	200 W RIDGE PIKE
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-3702
Country	:	US
Telephone Number	:	610-828-1274
Fax Number	:	610-828-0248

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

Provider Enumeration Date	:	05/31/2010
Last Update Date	:	05/31/2010

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Directions to “ MR. BARRY GILLES ” Practice Location

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