Provider Demographics
NPI:1609141670
Name:GILLAM, LINSEY ROSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LINSEY
Middle Name:ROSE
Last Name:GILLAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LINSEY
Other - Middle Name:ROSE
Other - Last Name:BLOUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6420 COLONEL GLENN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-7724
Mailing Address - Country:US
Mailing Address - Phone:501-565-9616
Mailing Address - Fax:501-565-9616
Practice Address - Street 1:6420 COLONEL GLENN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7724
Practice Address - Country:US
Practice Address - Phone:501-565-9616
Practice Address - Fax:501-565-9616
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist