Healthcare Provider Details

I. General information

NPI: 1386617850
Provider Name (Legal Business Name): GATTOLINE ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W REYNOLDS ST
PLANT CITY FL
33563-4733
US

IV. Provider business mailing address

1505 W REYNOLDS ST
PLANT CITY FL
33563-4733
US

V. Phone/Fax

Practice location:
  • Phone: 813-659-9777
  • Fax: 813-659-1485
Mailing address:
  • Phone: 813-659-9777
  • Fax: 813-659-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPH13764
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH13764
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH13764
License Number StateFL

VIII. Authorized Official

Name: MR. JOHN J GATTOLINE JR.
Title or Position: OWNER/PRES
Credential: RPH
Phone: 813-659-9777