Provider Demographics
NPI:1629257951
Name:GILHAM, LEE ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ALAN
Last Name:GILHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14210-2445
Mailing Address - Country:US
Mailing Address - Phone:716-674-4375
Mailing Address - Fax:
Practice Address - Street 1:2180 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14210-2445
Practice Address - Country:US
Practice Address - Phone:716-674-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33711OtherPHARMACIST