Provider Demographics
NPI:1477998813
Name:GALLEGOS, MICHAEL DARIO (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DARIO
Last Name:GALLEGOS
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 1:3620 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6631
Mailing Address - Country:US
Mailing Address - Phone:719-598-3578
Mailing Address - Fax:719-590-4522
Practice Address - Street 1:3620 AUSTIN BLUFFS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6631
Practice Address - Country:US
Practice Address - Phone:719-598-3578
Practice Address - Fax:719-590-4522
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist