MEDICARE: CARISSIA GILMER 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
1	183500000X	Pharmacist	08637	AR

General Provider Information

NPI Number	:	1750384210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSIA GILMER PHARMD

Provider Business Mailing Address
First Line	:	3648 HIGHWAY 301 S
Second Line	:
City	:	DELIGHT
State	:	AR
Zip	:	71940-8068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 S 4TH ST
Second Line	:
City	:	NASHVILLE
State	:	AR
Zip	:	71852-3009
Country	:	US
Telephone Number	:	870-845-1413
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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