Provider Demographics
NPI:1740768910
Name:GHALLY, EMAD E
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:E
Last Name:GHALLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 DUGAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4677
Mailing Address - Country:US
Mailing Address - Phone:904-304-8484
Mailing Address - Fax:
Practice Address - Street 1:505 NEW ROCHELLE RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4537
Practice Address - Country:US
Practice Address - Phone:914-668-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist