Provider Demographics
NPI:1164019923
Name:KILGALLEN, CORY WM (PHARMD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:WM
Last Name:KILGALLEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 BOWMAN DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3452
Mailing Address - Country:US
Mailing Address - Phone:775-636-0510
Mailing Address - Fax:
Practice Address - Street 1:292 LOS ALTOS PKWY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7708
Practice Address - Country:US
Practice Address - Phone:775-354-0104
Practice Address - Fax:775-354-0122
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist