Provider Demographics
NPI:1659501666
Name:GALLAHAN, JON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:GALLAHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 COMMONWEALTH CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2639
Mailing Address - Country:US
Mailing Address - Phone:804-639-7395
Mailing Address - Fax:
Practice Address - Street 1:4601 COMMONWEALTH CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2639
Practice Address - Country:US
Practice Address - Phone:804-639-7395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4834176OtherNABP
VA4838491OtherNABP
VA4841272OtherNABP
VA4829872OtherNABP
VA4829884OtherNABP
VA4829682OtherNABP
VA4830205OtherNABP
VA4832019OtherNABP
VA4840991OtherNABP
VA4830217OtherNABP
VA4838504OtherNABP
VA4840446OtherNABP