Provider Demographics
NPI:1760776025
Name:GILIS, ANGELINE PATRICIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINE
Middle Name:PATRICIA
Last Name:GILIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 SUMMER DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1850
Mailing Address - Country:US
Mailing Address - Phone:419-215-4635
Mailing Address - Fax:
Practice Address - Street 1:5225 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3139
Practice Address - Country:US
Practice Address - Phone:419-843-1622
Practice Address - Fax:419-843-1622
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-11009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist