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NPI Code Detail

MEDICARE: MR. ROBERT DOUGLAS GILLIS R.PH.

MEDICARE: MR. ROBERT DOUGLAS GILLIS R.PH.
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
1183500000XPharmacistPS22652FL

General Provider Information

NPI Number : 1861680811
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT DOUGLAS GILLIS R.PH.
Provider Business Mailing Address
First Line : 600 ANSIN BLVD
Second Line :
City : HALLANDALE BEACH
State : FL
Zip : 33009-2118
Country : US
Telephone Number : 954-874-4650
Fax Number : 954-455-1378
Provider Business Practice Location Address
First Line : 600 ANSIN BLVD
Second Line :
City : HALLANDALE BEACH
State : FL
Zip : 33009-2118
Country : US
Telephone Number : 954-874-4650
Fax Number : 954-455-1378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2007
Last Update Date : 08/10/2010

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