MEDICARE: MRS. COMELIA MARIE GILMORE CPHT

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	183700000X	Pharmacy Technician	320101050752239	WA

General Provider Information

NPI Number	:	1821122920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COMELIA MARIE GILMORE CPHT

Provider Business Mailing Address
First Line	:	7129 MALEY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5708
Country	:	US
Telephone Number	:	858-712-3950
Fax Number	:

Provider Business Practice Location Address
First Line	:	7129 MALEY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5708
Country	:	US
Telephone Number	:	858-712-3950
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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