Provider Demographics
NPI:1215213574
Name:GATENS, BRETT ROBERT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ROBERT
Last Name:GATENS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-2004
Mailing Address - Country:US
Mailing Address - Phone:317-898-9293
Mailing Address - Fax:317-895-1871
Practice Address - Street 1:9050 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-2004
Practice Address - Country:US
Practice Address - Phone:317-898-9293
Practice Address - Fax:317-895-1871
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023341A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist