Provider Demographics
NPI:1861680811
Name:GILLIS, ROBERT DOUGLAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:GILLIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ANSIN BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2118
Mailing Address - Country:US
Mailing Address - Phone:954-874-4650
Mailing Address - Fax:954-455-1378
Practice Address - Street 1:600 ANSIN BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2118
Practice Address - Country:US
Practice Address - Phone:954-874-4650
Practice Address - Fax:954-455-1378
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist