Provider Demographics
NPI:1710580261
Name:BARKDULL, GARY P (RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:BARKDULL
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 1:808 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT
Mailing Address - State:IN
Mailing Address - Zip Code:46928-2055
Mailing Address - Country:US
Mailing Address - Phone:765-618-9188
Mailing Address - Fax:
Practice Address - Street 1:4630 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5208
Practice Address - Country:US
Practice Address - Phone:765-674-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014682A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist