Healthcare Provider Details

I. General information

NPI: 1255251948
Provider Name (Legal Business Name): JENNIFER GALLAGHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CONSTITUTION RD
KENNEBUNK ME
04043-7206
US

IV. Provider business mailing address

9 CONSTITUTION RD
KENNEBUNK ME
04043-7206
US

V. Phone/Fax

Practice location:
  • Phone: 617-818-5048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH26375
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHCY-00979
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR47034
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: