Provider Demographics
NPI:1013777317
Name:GATLINS PHARMACY INC
Entity type:Organization
Organization Name:GATLINS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:BART
Authorized Official - Last Name:DORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-438-6605
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:MS
Mailing Address - Zip Code:38873-0369
Mailing Address - Country:US
Mailing Address - Phone:662-438-6605
Mailing Address - Fax:
Practice Address - Street 1:18 FIRST AVE
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:MS
Practice Address - Zip Code:38873-8441
Practice Address - Country:US
Practice Address - Phone:662-438-6605
Practice Address - Fax:662-438-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy