Provider Demographics
NPI:1356618458
Name:GATLIN, VIRGINIA JUNE
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:JUNE
Last Name:GATLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7813 HIGHWAY 72 W
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9559
Mailing Address - Country:US
Mailing Address - Phone:256-895-9326
Mailing Address - Fax:256-895-9879
Practice Address - Street 1:7813 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9559
Practice Address - Country:US
Practice Address - Phone:256-895-9326
Practice Address - Fax:256-895-9879
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist