Healthcare Provider Details

I. General information

NPI: 1003554957
Provider Name (Legal Business Name): JUSTIN R GALLAHER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 MING AVE STE A
BAKERSFIELD CA
93311-1319
US

IV. Provider business mailing address

301 DUMONT DR
BAKERSFIELD CA
93312-7080
US

V. Phone/Fax

Practice location:
  • Phone: 661-663-0171
  • Fax:
Mailing address:
  • Phone: 559-709-8367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: