Provider Demographics
NPI:1033401948
Name:MALLARI, GAIL SAMAR (RPH)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:SAMAR
Last Name:MALLARI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2601
Mailing Address - Country:US
Mailing Address - Phone:228-229-6488
Mailing Address - Fax:
Practice Address - Street 1:11279 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3396
Practice Address - Country:US
Practice Address - Phone:228-832-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist