Provider Demographics
NPI:1982019311
Name:GILLAM, ANITA J (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:J
Last Name:GILLAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FISHER FARM CT
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-5738
Mailing Address - Country:US
Mailing Address - Phone:704-798-0958
Mailing Address - Fax:
Practice Address - Street 1:323 S ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-5163
Practice Address - Country:US
Practice Address - Phone:704-639-9804
Practice Address - Fax:704-637-3536
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12362183500000X
SC8046183500000X
FLPS27614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist