Provider Demographics
NPI:1831950765
Name:WUKITSCH, GALLUS
Entity type:Individual
Prefix:
First Name:GALLUS
Middle Name:
Last Name:WUKITSCH
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 1:5930 BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-3121
Mailing Address - Country:US
Mailing Address - Phone:610-390-4824
Mailing Address - Fax:
Practice Address - Street 1:5930 BOTTOM RD
Practice Address - Street 2:
Practice Address - City:SLATINGTON
Practice Address - State:PA
Practice Address - Zip Code:18080-3121
Practice Address - Country:US
Practice Address - Phone:610-390-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist