Provider Demographics
NPI:1669805966
Name:GALLAHER, NICOLE ADELE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ADELE
Last Name:GALLAHER
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 1:2280 SAN MIGUEL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8160
Mailing Address - Country:US
Mailing Address - Phone:707-293-6242
Mailing Address - Fax:
Practice Address - Street 1:3093 MARLOW RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2426
Practice Address - Country:US
Practice Address - Phone:707-569-8504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-10
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist