Provider Demographics
NPI:1770873325
Name:GILMER, SCOTT J
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:GILMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-5012
Mailing Address - Country:US
Mailing Address - Phone:276-889-4149
Mailing Address - Fax:276-889-5844
Practice Address - Street 1:1094 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-5012
Practice Address - Country:US
Practice Address - Phone:276-889-4149
Practice Address - Fax:276-889-5844
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist