Provider Demographics
NPI:1750384210
Name:GILMER, CARISSIA (PHARMD)
Entity type:Individual
Prefix:
First Name:CARISSIA
Middle Name:
Last Name:GILMER
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 1:3648 HIGHWAY 301 S
Mailing Address - Street 2:
Mailing Address - City:DELIGHT
Mailing Address - State:AR
Mailing Address - Zip Code:71940-8068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1410 S 4TH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-3009
Practice Address - Country:US
Practice Address - Phone:870-845-1413
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR08637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist