Provider Demographics
NPI:1518366434
Name:GALE, IRENE (RPH)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:GALE
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 1:3 MAIZE TRL
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-8339
Mailing Address - Country:US
Mailing Address - Phone:505-867-1616
Mailing Address - Fax:505-867-9392
Practice Address - Street 1:3 MAIZE TRL
Practice Address - Street 2:
Practice Address - City:PLACITAS
Practice Address - State:NM
Practice Address - Zip Code:87043-8339
Practice Address - Country:US
Practice Address - Phone:505-867-1616
Practice Address - Fax:505-867-9392
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000056101835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist