Provider Demographics
NPI:1851685705
Name:GALLAGHER, MEGAN NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:NICOLE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:NICOLE
Other - Last Name:MITZNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7800 S LOVERS LANE RD
Mailing Address - Street 2:T-2388
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2290
Mailing Address - Country:US
Mailing Address - Phone:414-448-4001
Mailing Address - Fax:414-448-4011
Practice Address - Street 1:7800 S LOVERS LANE RD
Practice Address - Street 2:T-2388
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-2290
Practice Address - Country:US
Practice Address - Phone:414-448-4001
Practice Address - Fax:414-448-4011
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16091-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist