Individual
MEGAN GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
MILE POST 288 HWY 264, POLACCA, AZ 86042
(928) 737-6000
Mailing address
PO BOX 961, KEAMS CANYON, AZ 86034-0961
(516) 784-0767
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
27421
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27421
MARYLAND BOARD OF PHARMACY
MD
Enumeration date
09/21/2020
Last updated
09/21/2020
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