Provider Demographics
NPI:1376911511
Name:GATTI, THERESA DIANE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:DIANE
Last Name:GATTI
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2297
Mailing Address - Country:US
Mailing Address - Phone:503-566-5545
Mailing Address - Fax:503-566-5548
Practice Address - Street 1:1265 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2297
Practice Address - Country:US
Practice Address - Phone:503-566-5545
Practice Address - Fax:503-566-5548
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00149471835P0018X
ORRPH-0014947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist