MEDICARE: MR. JOHN J GATTOLINE JR. RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	15400	FL

General Provider Information

NPI Number	:	1518182971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN J GATTOLINE JR. RPH

Provider Business Mailing Address
First Line	:	11502 TULLAMORE ST
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-2455
Country	:	US
Telephone Number	:	813-988-6797
Fax Number	:	813-899-4999

Provider Business Practice Location Address
First Line	:	1615 SUN CITY CENTER PLZ
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5385
Country	:	US
Telephone Number	:	813-634-1729
Fax Number	:	813-899-4999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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