Provider Demographics
NPI:1790764942
Name:GARNER, GALE M (RPH)
Entity Type:Individual
Prefix:MR
First Name:GALE
Middle Name:M
Last Name:GARNER
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 1:130 WINDMILL DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-5955
Mailing Address - Country:US
Mailing Address - Phone:270-554-8063
Mailing Address - Fax:270-477-0113
Practice Address - Street 1:3524 PARK PLAZA RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-8900
Practice Address - Country:US
Practice Address - Phone:270-442-4579
Practice Address - Fax:270-450-0112
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-14
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist