Provider Demographics
NPI:1497208870
Name:DULEY, GAVIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:
Last Name:DULEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:KS
Mailing Address - Zip Code:67333-1462
Mailing Address - Country:US
Mailing Address - Phone:620-879-5822
Mailing Address - Fax:620-879-2721
Practice Address - Street 1:208 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANEY
Practice Address - State:KS
Practice Address - Zip Code:67333-1462
Practice Address - Country:US
Practice Address - Phone:620-879-5822
Practice Address - Fax:620-879-2721
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15260183500000X
IA22565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist