Provider Demographics
NPI:1710431515
Name:GILLILAND, JARED PAUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:PAUL
Last Name:GILLILAND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 3RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1187
Mailing Address - Country:US
Mailing Address - Phone:507-847-3282
Mailing Address - Fax:
Practice Address - Street 1:825 3RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1187
Practice Address - Country:US
Practice Address - Phone:507-847-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist