Provider Demographics
NPI:1073803078
Name:GILMAN, NATHANIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:GILMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 ELDERKIN AVE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4912
Mailing Address - Country:US
Mailing Address - Phone:401-290-7082
Mailing Address - Fax:860-440-3417
Practice Address - Street 1:75 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2423
Practice Address - Country:US
Practice Address - Phone:860-437-8880
Practice Address - Fax:860-440-3417
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist