Provider Demographics
NPI:1669873170
Name:WARTICK, GARRY
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:WARTICK
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 1:1111 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-3424
Mailing Address - Country:US
Mailing Address - Phone:620-326-5981
Mailing Address - Fax:620-326-4106
Practice Address - Street 1:1111 W 8TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-3424
Practice Address - Country:US
Practice Address - Phone:620-326-5981
Practice Address - Fax:620-326-4106
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist