Provider Demographics
NPI:1184215246
Name:GAMMILL, KAY C
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:C
Last Name:GAMMILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 RIVER FALL CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2614
Mailing Address - Country:US
Mailing Address - Phone:901-604-1438
Mailing Address - Fax:
Practice Address - Street 1:5055 COVINGTON WAY STE 6
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-5699
Practice Address - Country:US
Practice Address - Phone:901-383-8447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-074621835G0303X
TN654321835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric