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NPI Code Detail

MEDICARE: MRS. GILDA PRO SHORT RPH

MEDICARE: MRS. GILDA PRO SHORT RPH
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
1183500000XPharmacist25117TX

General Provider Information

NPI Number : 1568465904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GILDA PRO SHORT RPH
Provider Business Mailing Address
First Line : 7222 BROOKCOVE LN
Second Line :
City : DALLAS
State : TX
Zip : 75214-1946
Country : US
Telephone Number : 214-827-3837
Fax Number :
Provider Business Practice Location Address
First Line : 1300 E CAMPBELL RD
Second Line :
City : RICHARDSON
State : TX
Zip : 75081-1937
Country : US
Telephone Number : 972-813-3290
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 07/08/2007

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Directions to “ MRS. GILDA PRO SHORT RPH” Practice Location

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