Provider Demographics
NPI:1134316508
Name:GILBERT, SERITHA CAROL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SERITHA
Middle Name:CAROL
Last Name:GILBERT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SERITHA
Other - Middle Name:CAROL
Other - Last Name:COUNTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:221 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-4426
Mailing Address - Country:US
Mailing Address - Phone:478-287-6112
Mailing Address - Fax:
Practice Address - Street 1:655 7TH ST BLDG 700700-A
Practice Address - Street 2:78 MDG/SGHC-CREDENTIALS
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-287-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007731183500000X
GARPH021435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist