Provider Demographics
NPI:1679588438
Name:MACHALK, GLORIA E (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:E
Last Name:MACHALK
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 1:101 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434-1619
Mailing Address - Country:US
Mailing Address - Phone:478-625-7575
Mailing Address - Fax:478-625-7575
Practice Address - Street 1:101 E BROAD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434-1619
Practice Address - Country:US
Practice Address - Phone:478-625-7575
Practice Address - Fax:478-625-7575
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GARPH 013027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000357607AMedicaid
GA000357607BMedicaid