Provider Demographics
NPI:1689604522
Name:CALLAGHAN, MAXIMILIAN EMMETT
Entity Type:Individual
Prefix:MR
First Name:MAXIMILIAN
Middle Name:EMMETT
Last Name:CALLAGHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1823
Mailing Address - Country:US
Mailing Address - Phone:814-432-5958
Mailing Address - Fax:
Practice Address - Street 1:1262 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1322
Practice Address - Country:US
Practice Address - Phone:814-432-4125
Practice Address - Fax:814-432-2325
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP023582L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist