Provider Demographics
NPI:1932663614
Name:GILES, TEJLA MARIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:TEJLA
Middle Name:MARIE
Last Name:GILES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-1547
Mailing Address - Country:US
Mailing Address - Phone:315-287-2900
Mailing Address - Fax:315-287-7070
Practice Address - Street 1:371 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-1547
Practice Address - Country:US
Practice Address - Phone:315-287-2900
Practice Address - Fax:315-287-7070
Is Sole Proprietor?:No
Enumeration Date:2019-01-26
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist