Provider Demographics
NPI:1801193321
Name:DILLAVOU, GARY SHAUN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:SHAUN
Last Name:DILLAVOU
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 1:108 HIGHWAY 28 BYP
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-3742
Mailing Address - Country:US
Mailing Address - Phone:864-296-5208
Mailing Address - Fax:
Practice Address - Street 1:15 BRENDAN WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3562
Practice Address - Country:US
Practice Address - Phone:864-254-0251
Practice Address - Fax:864-254-0241
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21708183500000X
SC11184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist