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General NPI Number Information
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NPI Number | 1518058288
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Entity Type | Organization
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Legal Business Name | GATLINS PHARMACY INC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 18 FIRST AVE
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City | TISHOMINGO
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State | MS
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Zip | 38873-8441
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Country | US
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Telephone | 662-438-6605
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Fax | 662-438-6680
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Provider Business Mailing Address
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Address Line | PO BOX 369
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City | TISHOMINGO
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State | MS
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Zip | 38873-0369
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Country | US
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Telephone | 662-438-6605
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Fax | 662-438-6680
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Authorized Official
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Title or Position | OWNER
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Name | JESSE DORAN
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Credential |
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Telephone | 662-438-6605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 00799011
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License Number State | MS
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