Provider Demographics
NPI:1639499874
Name:GALLAGHER, MARIA (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GALLAGHER
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 1:275 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:15042-1103
Mailing Address - Country:US
Mailing Address - Phone:724-728-4742
Mailing Address - Fax:
Practice Address - Street 1:1021 1ST AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:PA
Practice Address - Zip Code:15027-1666
Practice Address - Country:US
Practice Address - Phone:724-869-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028971L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP028971LOtherPHARMACY STATE LICENSE