Provider Demographics
NPI:1376820761
Name:GILLES, JAMIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GILLES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 VILLAGE LAKE CT APT 201
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-3461
Mailing Address - Country:US
Mailing Address - Phone:910-433-4681
Mailing Address - Fax:910-433-2892
Practice Address - Street 1:512 VILLAG LAKE COURT APT # 201
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390
Practice Address - Country:US
Practice Address - Phone:910-433-4681
Practice Address - Fax:910-433-2892
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist