Provider Demographics
NPI:1346844826
Name:TRAUTH, GARY MICHAEL
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MICHAEL
Last Name:TRAUTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 N STARR RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47108-6254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3511
Practice Address - Country:US
Practice Address - Phone:812-522-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019287A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist