MEDICARE: SUSAN M 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	02616335A	IN

General Provider Information

NPI Number	:	1720635584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M GALLAGHER RPH

Provider Business Mailing Address
First Line	:	511 3RD ST
Second Line	:
City	:	COVINGTON
State	:	IN
Zip	:	47932-1119
Country	:	US
Telephone Number	:	765-793-4511
Fax Number	:	765-793-3907

Provider Business Practice Location Address
First Line	:	511 3RD ST
Second Line	:
City	:	COVINGTON
State	:	IN
Zip	:	47932-1119
Country	:	US
Telephone Number	:	765-793-4511
Fax Number	:

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

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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Directions to “ SUSAN M GALLAGHER RPH” Practice Location

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