Individual
JACK EDWARD GILLUM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHARM.D
Contact information
Practice address
6010 W AMARILLO BLVD, AMARILLO, TX 79106-1990
(806) 355-9703
Mailing address
4212 VANCE AVE, AMARILLO, TX 79110-3606
(806) 355-2303
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
9175
OK
Other
Enumeration date
08/10/2005
Last updated
07/08/2007
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