Provider Demographics
NPI:1417002387
Name:GALLAGHER, JUDY RIADON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:RIADON
Last Name:GALLAGHER
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 1:15 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2553
Mailing Address - Country:US
Mailing Address - Phone:270-821-1401
Mailing Address - Fax:
Practice Address - Street 1:86 MADISON SQUARE DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2740
Practice Address - Country:US
Practice Address - Phone:270-821-5811
Practice Address - Fax:270-825-4908
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist