Provider Demographics
NPI:1689214363
Name:GALLICIO, GWENDOLYN ANN (RPH)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:ANN
Last Name:GALLICIO
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 1:140 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1325
Mailing Address - Country:US
Mailing Address - Phone:267-227-8727
Mailing Address - Fax:
Practice Address - Street 1:200 MILL RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1434
Practice Address - Country:US
Practice Address - Phone:610-650-3927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist