Provider Demographics
NPI:1306972559
Name:GILSTRAP, ERNEST LEE JR (RPH)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:LEE
Last Name:GILSTRAP
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N WEST ST
Mailing Address - Street 2:RIVER PLAZA
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817-3677
Mailing Address - Country:US
Mailing Address - Phone:229-246-0472
Mailing Address - Fax:
Practice Address - Street 1:411 N WEST ST
Practice Address - Street 2:RIVER PLAZA
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-3677
Practice Address - Country:US
Practice Address - Phone:229-246-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist