MEDICARE: MR. DANIEL WILLIAM GALLAGHER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	6704	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6704	OTHER	CT	RPH LICENSE NUMBER

General Provider Information

NPI Number	:	1679741847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL WILLIAM GALLAGHER RPH

Provider Business Mailing Address
First Line	:	66 ACORN DR
Second Line	:
City	:	WESTBROOK
State	:	CT
Zip	:	06498-1594
Country	:	US
Telephone Number	:	860-399-2372
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 WASHINGTON ST
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-2912
Country	:	US
Telephone Number	:	860-344-1551
Fax Number	:	860-344-1560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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