Provider Demographics
NPI:1407832504
Name:GALLIGAN, GERALD LAWRENCE
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:LAWRENCE
Last Name:GALLIGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:40502 TIMBERLINE DRIVE E
Mailing Address - Street 2:3601 6TH AVE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406
Mailing Address - Country:US
Mailing Address - Phone:360-832-8126
Mailing Address - Fax:
Practice Address - Street 1:3601 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5405
Practice Address - Country:US
Practice Address - Phone:253-761-1248
Practice Address - Fax:253-761-7462
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00017283OtherLICENSE NUMBER