Provider Demographics
NPI:1700167384
Name:GAILLARD, KATHLIN LANGSTON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KATHLIN
Middle Name:LANGSTON
Last Name:GAILLARD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:KATHLIN
Other - Middle Name:DIANE
Other - Last Name:LANGSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:11927 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4602
Mailing Address - Country:US
Mailing Address - Phone:865-671-0932
Mailing Address - Fax:865-671-0964
Practice Address - Street 1:11927 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-4602
Practice Address - Country:US
Practice Address - Phone:865-671-0932
Practice Address - Fax:865-671-0964
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36246183500000X
MSE010743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist