Provider Demographics
NPI:1770992851
Name:GALLACCHI, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GALLACCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BALLTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309
Mailing Address - Country:US
Mailing Address - Phone:518-374-7730
Mailing Address - Fax:518-374-6470
Practice Address - Street 1:1330 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:NISKAYUANA
Practice Address - State:NY
Practice Address - Zip Code:12309
Practice Address - Country:US
Practice Address - Phone:518-374-7730
Practice Address - Fax:518-374-6470
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist