Provider Demographics
NPI:1700833779
Name:GAGLIARDI, ALFONSE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALFONSE
Middle Name:
Last Name:GAGLIARDI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9446
Mailing Address - Country:US
Mailing Address - Phone:610-869-3200
Mailing Address - Fax:610-869-4221
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 109
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:610-869-3200
Practice Address - Fax:610-869-4221
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410390L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist