Provider Demographics
NPI:1548458813
Name:MINNICK, GAIL M (RPH)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:MINNICK
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 1:939 VETERANS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-2602
Mailing Address - Country:US
Mailing Address - Phone:812-352-9700
Mailing Address - Fax:812-352-9702
Practice Address - Street 1:939 VETERANS DR
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-2602
Practice Address - Country:US
Practice Address - Phone:812-352-9700
Practice Address - Fax:812-352-9702
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012807A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26012807AOtherSTATE LICENSE