Provider Demographics
NPI:1760465017
Name:GALLEGOS, PATRICK JULIAN (PHAMRD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JULIAN
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:PHAMRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 NICHOLSON DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3765
Mailing Address - Country:US
Mailing Address - Phone:330-653-9577
Mailing Address - Fax:330-325-5930
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-6614
Practice Address - Fax:330-996-2395
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX424011835P1200X
OH03-1-276221835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy