Provider Demographics
NPI:1326498114
Name:GILL, GURAJIT
Entity Type:Individual
Prefix:DR
First Name:GURAJIT
Middle Name:
Last Name:GILL
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 1:3644 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1044
Mailing Address - Country:US
Mailing Address - Phone:773-523-1700
Mailing Address - Fax:773-523-1855
Practice Address - Street 1:3644 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1044
Practice Address - Country:US
Practice Address - Phone:773-523-1700
Practice Address - Fax:773-523-1855
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist