Provider Demographics
NPI:1720635584
Name:GALLAGHER, SUSAN M (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:GALLAGHER
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 1:511 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47932-1119
Mailing Address - Country:US
Mailing Address - Phone:765-793-4511
Mailing Address - Fax:765-793-3907
Practice Address - Street 1:511 3RD ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1119
Practice Address - Country:US
Practice Address - Phone:765-793-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02616335A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist