Provider Demographics
NPI:1275145914
Name:GALLANT, AMY B (RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:GALLANT
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 1:135 PLEASANT ST APT 405
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-7187
Mailing Address - Country:US
Mailing Address - Phone:617-388-3507
Mailing Address - Fax:
Practice Address - Street 1:135 PLEASANT ST APT 405
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-7187
Practice Address - Country:US
Practice Address - Phone:617-388-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist