Provider Demographics
NPI:1366043895
Name:GILLEY, BARBARA JANE (RPH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JANE
Last Name:GILLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 N BEAL PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3048
Mailing Address - Country:US
Mailing Address - Phone:850-862-0101
Mailing Address - Fax:850-862-0381
Practice Address - Street 1:740 BEAL PKWY NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3048
Practice Address - Country:US
Practice Address - Phone:850-862-0101
Practice Address - Fax:850-862-0381
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist