Provider Demographics
NPI:1215531900
Name:GAULDIN, THURMON JAY JR
Entity type:Individual
Prefix:
First Name:THURMON
Middle Name:JAY
Last Name:GAULDIN
Suffix:JR
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 1:635 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-5102
Mailing Address - Country:US
Mailing Address - Phone:717-637-5228
Mailing Address - Fax:717-637-2573
Practice Address - Street 1:635 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-5102
Practice Address - Country:US
Practice Address - Phone:717-637-5228
Practice Address - Fax:717-637-2573
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI004975183500000X
PARP045350R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist