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NPI Code Detail

MEDICARE: MANDY LYNN GILMOUR RPH

MEDICARE: MANDY LYNN GILMOUR 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
1183500000XPharmacist03-2-23567OH

General Provider Information

NPI Number : 1679581029
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDY LYNN GILMOUR RPH
Provider Business Mailing Address
First Line : 105 N KENNEBEC AVE
Second Line :
City : MCCONNELSVILLE
State : OH
Zip : 43756-1254
Country : US
Telephone Number : 740-962-2552
Fax Number : 740-962-2730
Provider Business Practice Location Address
First Line : 105 N KENNEBEC AVE
Second Line :
City : MCCONNELSVILLE
State : OH
Zip : 43756-1254
Country : US
Telephone Number : 740-962-2552
Fax Number : 740-962-2730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 07/24/2008

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