Provider Demographics
NPI:1609320043
Name:GILL, MAURA ELIZABETH
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:ELIZABETH
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E NORTHAMPTON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-2400
Mailing Address - Country:US
Mailing Address - Phone:570-328-4059
Mailing Address - Fax:
Practice Address - Street 1:14 E NORTHAMPTON ST STE 201
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-2400
Practice Address - Country:US
Practice Address - Phone:570-328-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-14
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist