Provider Demographics
NPI:1437555349
Name:GALLOVITCH, EDWARD JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:GALLOVITCH
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 1:2750 NC 55 HWY
Mailing Address - Street 2:WALMART #4157
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6205
Mailing Address - Country:US
Mailing Address - Phone:919-335-0056
Mailing Address - Fax:919-335-0052
Practice Address - Street 1:2750 NC 55 HWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6205
Practice Address - Country:US
Practice Address - Phone:919-335-0056
Practice Address - Fax:919-335-0052
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist