Provider Demographics
NPI:1255424693
Name:GATRELL 6 ENTERPRISES LLC
Entity type:Organization
Organization Name:GATRELL 6 ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-287-1158
Mailing Address - Street 1:714 KIHEKAH AVE
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-3206
Mailing Address - Country:US
Mailing Address - Phone:918-287-1317
Mailing Address - Fax:918-287-1158
Practice Address - Street 1:714 KIHEKAH AVE
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-3206
Practice Address - Country:US
Practice Address - Phone:918-287-1317
Practice Address - Fax:918-287-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100237390AMedicaid
2073862OtherPK