Provider Demographics
NPI:1528180783
Name:GILKINSON, MARY ELLEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:
Last Name:GILKINSON
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 1:42 CAPTIVA CROSSING
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8630
Mailing Address - Country:US
Mailing Address - Phone:585-388-7734
Mailing Address - Fax:
Practice Address - Street 1:3660 DEWEY AVENUE
Practice Address - Street 2:WEGMANS
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-3026
Practice Address - Country:US
Practice Address - Phone:585-621-5600
Practice Address - Fax:585-621-9467
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00799808Medicaid