Provider Demographics
NPI:1568445161
Name:GILLILAND, TRACI T (PHARM D)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:T
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8458 LAWNPARK DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-7000
Mailing Address - Country:US
Mailing Address - Phone:865-541-3671
Mailing Address - Fax:865-541-3135
Practice Address - Street 1:1901 W CLINCH AVE
Practice Address - Street 2:FORT SANDERS REGIONAL MEDICAL CENTER PHARMACY DEPARTMEN
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2307
Practice Address - Country:US
Practice Address - Phone:865-541-3671
Practice Address - Fax:865-541-3135
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist