Provider Demographics
NPI:1619105418
Name:GALLAGHER, JOHN HUGH SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HUGH
Last Name:GALLAGHER
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1409 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4137
Mailing Address - Country:US
Mailing Address - Phone:718-377-7724
Mailing Address - Fax:718-377-1675
Practice Address - Street 1:1409 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4137
Practice Address - Country:US
Practice Address - Phone:718-377-7724
Practice Address - Fax:718-377-1675
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036062-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist