Basic Information
Provider Information
NPI: 1558890046
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILL
FirstName: ROHAIL
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: PHARMACIST
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1901 1ST AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100297404
CountryCode: US
TelephoneNumber: 2124237735
FaxNumber: 2124236661
Practice Location
Address1: 1901 1ST AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100297404
CountryCode: US
TelephoneNumber: 2124237735
FaxNumber: 2124236661
Other Information
ProviderEnumerationDate: 06/08/2017
LastUpdateDate: 06/08/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X041579-2NYY193400000X SINGLE SPECIALTY GROUPPharmacy Service ProvidersPharmacist 

No ID Information.


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