Provider Demographics
NPI:1740568344
Name:GALLERANI, MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GALLERANI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-2460
Mailing Address - Country:US
Mailing Address - Phone:860-824-5481
Mailing Address - Fax:
Practice Address - Street 1:76 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-2460
Practice Address - Country:US
Practice Address - Phone:860-824-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-30
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist