Provider Demographics
NPI:1740517630
Name:GILLOCK, AMY COLETTE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:COLETTE
Last Name:GILLOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WEST RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1131
Mailing Address - Country:US
Mailing Address - Phone:281-445-1308
Mailing Address - Fax:
Practice Address - Street 1:105 WEST RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1131
Practice Address - Country:US
Practice Address - Phone:281-445-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40811183500000X
IL051.293089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist