Basic Information
Provider Information
NPI: 1457415770
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILLETTE
FirstName: SARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 206 GRACE ST
Address2:  
City: SEAFORD
State: VA
PostalCode: 236962335
CountryCode: US
TelephoneNumber: 7573695825
FaxNumber:  
Practice Location
Address1: 576 JEFFERSON AVE
Address2:  
City: FORT EUSTIS
State: VA
PostalCode: 236045548
CountryCode: US
TelephoneNumber: 7573147900
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/21/2006
LastUpdateDate: 10/12/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X0202204289VAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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