Provider Demographics
NPI:1295064475
Name:GALLEGOS, NANCY (PHARMD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 GRASSY CT
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5997
Mailing Address - Country:US
Mailing Address - Phone:808-298-4338
Mailing Address - Fax:
Practice Address - Street 1:2200 N HWY A1A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32903-2511
Practice Address - Country:US
Practice Address - Phone:321-773-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3781183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist