Basic Information
Provider Information
NPI: 1457333627
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAYLOR
FirstName: ALLYSON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PHARM D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 411 JUNEAU AVE
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794164151
CountryCode: US
TelephoneNumber: 8065357993
FaxNumber: 8067434209
Practice Location
Address1: TEXAS TECH SCHOOL OF PHARMACY
Address2: 3601 4TH STREET, MS 8162
City: LUBBOCK
State: TX
PostalCode: 794300001
CountryCode: US
TelephoneNumber: 8067434200
FaxNumber: 8067434209
Other Information
ProviderEnumerationDate: 11/15/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1835P1200X37073TXY Pharmacy Service ProvidersPharmacistPharmacotherapy

No ID Information.


Home