Provider Demographics
NPI:1760761670
Name:GILLESPIE, JOHN BRENDAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRENDAN
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21221 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2850
Mailing Address - Country:US
Mailing Address - Phone:347-408-4163
Mailing Address - Fax:
Practice Address - Street 1:2425 WATERBURY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5510
Practice Address - Country:US
Practice Address - Phone:718-882-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0488711835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear