Provider Demographics
NPI:1932963600
Name:GILLIAM, NATASHA NICOLE (PHARMD RPH)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLE
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BIRCHCANE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5993
Mailing Address - Country:US
Mailing Address - Phone:864-594-2714
Mailing Address - Fax:
Practice Address - Street 1:729 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3218
Practice Address - Country:US
Practice Address - Phone:864-454-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist