Provider Demographics
NPI:1780284364
Name:GILMORE, KEITH II (PHARMD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:GILMORE
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13813 TIDEWATER CREST LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4589
Mailing Address - Country:US
Mailing Address - Phone:281-813-0479
Mailing Address - Fax:
Practice Address - Street 1:10250 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4734
Practice Address - Country:US
Practice Address - Phone:281-431-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist