Healthcare Provider Details

I. General information

NPI: 1235230426
Provider Name (Legal Business Name): GAYLON PAUL GAUTIER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 SPICED BUTTER RUM ST
NORTH LAS VEGAS NV
89084-1328
US

IV. Provider business mailing address

6440 SPICED BUTTER RUM ST
NORTH LAS VEGAS NV
89084-1328
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-3213
  • Fax:
Mailing address:
  • Phone: 702-653-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number38387
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: