Provider Demographics
NPI:1689690547
Name:GILL, RONALD L (RPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:GILL
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:PO BOX 14169
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99214-0169
Mailing Address - Country:US
Mailing Address - Phone:509-928-9500
Mailing Address - Fax:509-928-9504
Practice Address - Street 1:11406 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5224
Practice Address - Country:US
Practice Address - Phone:509-928-9500
Practice Address - Fax:509-928-9504
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4901220OtherNABP NUMBER
WA6033906Medicaid
WA0216880001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER