Provider Demographics
NPI:1841051299
Name:GILMAN PHARMACY LLC
Entity type:Organization
Organization Name:GILMAN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUELTZO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:708-254-0498
Mailing Address - Street 1:1042 S CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:GILMAN
Mailing Address - State:IL
Mailing Address - Zip Code:60938-6134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1042 S CRESCENT ST
Practice Address - Street 2:
Practice Address - City:GILMAN
Practice Address - State:IL
Practice Address - Zip Code:60938-6134
Practice Address - Country:US
Practice Address - Phone:708-254-0498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GILMAN PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy