Provider Demographics
NPI:1659788578
Name:SIMRIN GILL
Entity Type:Organization
Organization Name:SIMRIN GILL
Other - Org Name:GILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CASHIER
Authorized Official - Prefix:
Authorized Official - First Name:SIMRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-604-5533
Mailing Address - Street 1:2600 MITCHELL RD
Mailing Address - Street 2:STE G
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-9468
Mailing Address - Country:US
Mailing Address - Phone:209-585-4500
Mailing Address - Fax:209-320-3513
Practice Address - Street 1:2600 MITCHELL RD STE G
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-9466
Practice Address - Country:US
Practice Address - Phone:209-585-4500
Practice Address - Fax:209-320-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146834OtherPK