Provider Demographics
NPI:1629378914
Name:GALLEGOS, MILLICENT LANDIS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MILLICENT
Middle Name:LANDIS
Last Name:GALLEGOS
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 1:11088 WEST JEWELL AVE
Mailing Address - Street 2:SAFEWAY 2342
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80129
Mailing Address - Country:US
Mailing Address - Phone:303-989-8812
Mailing Address - Fax:303-989-6903
Practice Address - Street 1:11088 WEST JEWELL AVE
Practice Address - Street 2:SAFEWAY 2342
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80129
Practice Address - Country:US
Practice Address - Phone:303-989-8812
Practice Address - Fax:303-989-6903
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist