Provider Demographics
NPI:1982233300
Name:GALLOGLY, EMILY
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:GALLOGLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GARY GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-8001
Mailing Address - Country:US
Mailing Address - Phone:770-876-7775
Mailing Address - Fax:
Practice Address - Street 1:2246 WINCHESTER RD NE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-6800
Practice Address - Country:US
Practice Address - Phone:256-581-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL18964OtherPHARMACIST LICENSE FOR AL