Provider Demographics
NPI:1548568165
Name:MEDLIN, GARY MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:MEDLIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 W DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8746
Mailing Address - Country:US
Mailing Address - Phone:704-753-2076
Mailing Address - Fax:704-753-9126
Practice Address - Street 1:4307 WILGROVE MINT HILL RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3400
Practice Address - Country:US
Practice Address - Phone:704-545-3420
Practice Address - Fax:704-573-4227
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist