Provider Demographics
NPI:1568465904
Name:SHORT, GILDA PRO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GILDA
Middle Name:PRO
Last Name:SHORT
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 1:7222 BROOKCOVE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1946
Mailing Address - Country:US
Mailing Address - Phone:214-827-3837
Mailing Address - Fax:
Practice Address - Street 1:1300 E CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1937
Practice Address - Country:US
Practice Address - Phone:972-813-3290
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist