Provider Demographics
NPI:1033522909
Name:GITAU, GILBERT (PHAMD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:GITAU
Suffix:
Gender:M
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5628 CARRIAGE FLS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2153
Mailing Address - Country:US
Mailing Address - Phone:302-981-6163
Mailing Address - Fax:
Practice Address - Street 1:2559 JACKSON KELLER RD STE 2561
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5246
Practice Address - Country:US
Practice Address - Phone:210-348-1532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-08
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20941183500000X
TX57976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist