Provider Demographics
NPI:1992227854
Name:GATLIN FAMILY PHARMACY LLC
Entity type:Organization
Organization Name:GATLIN FAMILY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-388-1258
Mailing Address - Street 1:420 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-3125
Mailing Address - Country:US
Mailing Address - Phone:620-672-7447
Mailing Address - Fax:620-672-6236
Practice Address - Street 1:420 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3125
Practice Address - Country:US
Practice Address - Phone:620-672-7447
Practice Address - Fax:620-672-6236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
KS2-1016723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201168120AMedicaid
7627490001OtherPTAN DMEPOS
KA4364OtherPTAN IMMUNIZATIONS