Provider Demographics
NPI:1720302060
Name:GALLANT, MARION LORETTA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:LORETTA
Last Name:GALLANT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PUEBLO TRL
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3148
Mailing Address - Country:US
Mailing Address - Phone:973-209-6062
Mailing Address - Fax:
Practice Address - Street 1:1495 UNION VALLEY RD
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1361
Practice Address - Country:US
Practice Address - Phone:973-728-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01800000183500000X
NJ28RJ00048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist