Healthcare Provider Details

I. General information

NPI: 1538638408
Provider Name (Legal Business Name): LEANNE ROSE GALLANT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NORTH ST
HOULTON ME
04730-1832
US

IV. Provider business mailing address

137 NORTH ST
HOULTON ME
04730-1832
US

V. Phone/Fax

Practice location:
  • Phone: 207-532-6876
  • Fax:
Mailing address:
  • Phone: 207-532-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR68758
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: