Provider Demographics
NPI:1205134574
Name:RUFFIN, GILLIAN GP (RPH)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:GP
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:GILLIAN
Other - Middle Name:GP
Other - Last Name:DOUGLAS-RUFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:833 BATTLEFIELD BLVD N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4871
Mailing Address - Country:US
Mailing Address - Phone:757-382-9717
Mailing Address - Fax:757-548-8597
Practice Address - Street 1:833 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4871
Practice Address - Country:US
Practice Address - Phone:757-382-9717
Practice Address - Fax:757-548-8597
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist