Provider Demographics
NPI:1154405017
Name:GILFILLAN CLINIC PHARMACY
Entity type:Organization
Organization Name:GILFILLAN CLINIC PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SADARO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:641-664-2349
Mailing Address - Street 1:101 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1606
Mailing Address - Country:US
Mailing Address - Phone:641-664-2349
Mailing Address - Fax:641-664-2464
Practice Address - Street 1:101 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1606
Practice Address - Country:US
Practice Address - Phone:641-664-2349
Practice Address - Fax:641-664-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0145854Medicaid
IA0145854Medicaid