Provider Demographics
NPI:1679581029
Name:GILMOUR, MANDY LYNN (RPH)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNN
Last Name:GILMOUR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N KENNEBEC AVE
Mailing Address - Street 2:
Mailing Address - City:MCCONNELSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43756-1254
Mailing Address - Country:US
Mailing Address - Phone:740-962-2552
Mailing Address - Fax:740-962-2730
Practice Address - Street 1:105 N KENNEBEC AVE
Practice Address - Street 2:
Practice Address - City:MCCONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-1254
Practice Address - Country:US
Practice Address - Phone:740-962-2552
Practice Address - Fax:740-962-2730
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-23567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist