Provider Demographics
NPI:1841278710
Name:GALLAGHER, MARY LORRAINE (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LORRAINE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE D
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4600
Mailing Address - Country:US
Mailing Address - Phone:253-460-1879
Mailing Address - Fax:253-564-1412
Practice Address - Street 1:2700 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE D
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4600
Practice Address - Country:US
Practice Address - Phone:253-460-1879
Practice Address - Fax:253-564-1412
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH0017315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist