Provider Demographics
NPI:1316224850
Name:GILBERT, SHIRLEY CAROL (CPHT)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:CAROL
Last Name:GILBERT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6023 STINSON ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-6453
Mailing Address - Country:US
Mailing Address - Phone:731-676-1800
Mailing Address - Fax:731-855-2756
Practice Address - Street 1:2045 US HIGHWAY 45 BYP S
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-2940
Practice Address - Country:US
Practice Address - Phone:731-855-9222
Practice Address - Fax:731-855-2756
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5301-0701-0136-923183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician