Provider Demographics
NPI:1508194796
Name:GOURLEY, DEREK ALAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ALAN
Last Name:GOURLEY
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 1:3010 GARRETT DR
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-5322
Mailing Address - Country:US
Mailing Address - Phone:806-435-3759
Mailing Address - Fax:806-435-2740
Practice Address - Street 1:3102 GARRETT DR
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-5324
Practice Address - Country:US
Practice Address - Phone:806-435-3759
Practice Address - Fax:806-435-2740
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-26
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist