Provider Demographics
NPI:1780895391
Name:CALLAHAN, GAYLE L (RPH)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:L
Last Name:CALLAHAN
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 1:2340 ARDEN DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-3861
Mailing Address - Country:US
Mailing Address - Phone:941-378-5419
Mailing Address - Fax:941-378-8819
Practice Address - Street 1:2340 ARDEN DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-3861
Practice Address - Country:US
Practice Address - Phone:941-378-5419
Practice Address - Fax:941-378-8819
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist