Provider Demographics
NPI:1881959815
Name:GADDIS, BARRY LEE (RPH)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:LEE
Last Name:GADDIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 SHADEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-8819
Mailing Address - Country:US
Mailing Address - Phone:270-313-9540
Mailing Address - Fax:
Practice Address - Street 1:3351 SHADEWOOD TER
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-8819
Practice Address - Country:US
Practice Address - Phone:270-313-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7877183500000X
IN26020703A183500000X
MSE-6151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist