Provider Demographics
NPI:1164754503
Name:GALECKI, BRYAN ALEXANDER (RPH)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:ALEXANDER
Last Name:GALECKI
Suffix:
Gender:M
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:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-0012
Mailing Address - Country:US
Mailing Address - Phone:845-542-0167
Mailing Address - Fax:
Practice Address - Street 1:39 N PLANK RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2118
Practice Address - Country:US
Practice Address - Phone:845-561-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2829909Medicaid