Provider Demographics
NPI:1386617850
Name:GATTOLINE ENTERPRISES, INC
Entity type:Organization
Organization Name:GATTOLINE ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GATTOLINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-659-9777
Mailing Address - Street 1:1505 W REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4733
Mailing Address - Country:US
Mailing Address - Phone:813-659-9777
Mailing Address - Fax:813-659-1485
Practice Address - Street 1:1505 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4733
Practice Address - Country:US
Practice Address - Phone:813-659-9777
Practice Address - Fax:813-659-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH13764332B00000X, 333600000X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103409000Medicaid
1108750001Medicare NSC