Healthcare Provider Details

I. General information

NPI: 1790622611
Provider Name (Legal Business Name): GRANT GALLAGHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13250 W MAPLE RD
OMAHA NE
68164-2462
US

IV. Provider business mailing address

13250 W MAPLE RD
OMAHA NE
68164-2462
US

V. Phone/Fax

Practice location:
  • Phone: 402-965-8339
  • Fax: 402-496-9589
Mailing address:
  • Phone: 402-965-8339
  • Fax: 402-496-9589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18142
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: