Individual
JARED MASON GILLINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
19505 N SUNRISE BLVD # SURPRISE, SURPRISE, AZ 85374-4739
(623) 556-4778
Mailing address
10947 W ROYAL PALM RD, PEORIA, AZ 85345-1900
(608) 475-1507
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S023318
AZ
Other
Enumeration date
08/28/2018
Last updated
08/28/2018
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