Provider Demographics
NPI:1831404573
Name:GATHURA, ALFRED MICHAEL
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:MICHAEL
Last Name:GATHURA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ALFRED
Other - Middle Name:MICHAEL
Other - Last Name:GATHURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:196 E PEMBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-4002
Mailing Address - Country:US
Mailing Address - Phone:302-740-8212
Mailing Address - Fax:
Practice Address - Street 1:101 N EAST PLZ
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3633
Practice Address - Country:US
Practice Address - Phone:410-287-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist