Provider Demographics
NPI:1134370455
Name:GALLERY PHARMACIES INC
Entity type:Organization
Organization Name:GALLERY PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:GAURAV
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHATMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-904-3404
Mailing Address - Street 1:141 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522
Mailing Address - Country:US
Mailing Address - Phone:973-904-3404
Mailing Address - Fax:973-720-8411
Practice Address - Street 1:141 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522
Practice Address - Country:US
Practice Address - Phone:973-904-3404
Practice Address - Fax:973-720-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006831003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3195408OtherNCPDP PROVIDER IDENTIFICATION NUMBER