Provider Demographics
NPI:1922145853
Name:GALLAGHER, TIM J (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:J
Last Name:GALLAGHER
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 1:31536 CANNON RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-6413
Mailing Address - Country:US
Mailing Address - Phone:507-438-0948
Mailing Address - Fax:
Practice Address - Street 1:905 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3357
Practice Address - Country:US
Practice Address - Phone:507-433-7447
Practice Address - Fax:507-433-1632
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist