Provider Demographics
NPI:1710077938
Name:GILL, TIMOTHY W (DPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:W
Last Name:GILL
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4303 PITMAN AND THOMAS
Mailing Address - Street 2:SUITE 135
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-0326
Mailing Address - Country:US
Mailing Address - Phone:580-353-1131
Mailing Address - Fax:580-353-0389
Practice Address - Street 1:4303 PITMAN AND THOMAS
Practice Address - Street 2:SUITE 135
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-0326
Practice Address - Country:US
Practice Address - Phone:580-353-1131
Practice Address - Fax:580-353-0389
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist