Provider Demographics
NPI:1033201702
Name:GILLEY'S PHARMACY, INC
Entity Type:Organization
Organization Name:GILLEY'S PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:GILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-946-5111
Mailing Address - Street 1:2600 W JEFFERSON
Mailing Address - Street 2:227
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211
Mailing Address - Country:US
Mailing Address - Phone:214-946-5111
Mailing Address - Fax:214-946-1113
Practice Address - Street 1:2600 W JEFFERSON
Practice Address - Street 2:227
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211
Practice Address - Country:US
Practice Address - Phone:214-946-5111
Practice Address - Fax:214-946-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00174333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110571Medicaid
TX110571Medicaid