Provider Demographics
NPI:1326367319
Name:GILLES, BARRY
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:GILLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W RIDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-3702
Mailing Address - Country:US
Mailing Address - Phone:610-828-1274
Mailing Address - Fax:610-828-0248
Practice Address - Street 1:200 W RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-3702
Practice Address - Country:US
Practice Address - Phone:610-828-1274
Practice Address - Fax:610-828-0248
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP024937L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist