Provider Demographics
NPI:1245489095
Name:TRUELOVE, GARY ANTHONY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ANTHONY
Last Name:TRUELOVE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10767 E CARSON CITY RD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-9560
Mailing Address - Country:US
Mailing Address - Phone:989-584-3077
Mailing Address - Fax:989-584-2537
Practice Address - Street 1:10767 E CARSON CITY RD
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-9560
Practice Address - Country:US
Practice Address - Phone:989-584-3077
Practice Address - Fax:989-584-2537
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist