Provider Demographics
NPI:1013324524
Name:GATLIN, TERRY LYNN (BSPHARM)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LYNN
Last Name:GATLIN
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 E 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124
Mailing Address - Country:US
Mailing Address - Phone:620-672-5584
Mailing Address - Fax:620-672-0508
Practice Address - Street 1:1108 E 1ST ST
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-2060
Practice Address - Country:US
Practice Address - Phone:620-672-5584
Practice Address - Fax:620-672-0508
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist