Provider Demographics
NPI:1023159134
Name:WORLEY, GARY W
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:W
Last Name:WORLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HILHAM HWY
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-8126
Mailing Address - Country:US
Mailing Address - Phone:931-823-6796
Mailing Address - Fax:931-823-1324
Practice Address - Street 1:718 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1720
Practice Address - Country:US
Practice Address - Phone:931-823-1245
Practice Address - Fax:931-823-1324
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist