Healthcare Provider Details

I. General information

NPI: 1134370455
Provider Name (Legal Business Name): GALLERY PHARMACIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 WEST BROADWAY
PATERSON NJ
07522
US

IV. Provider business mailing address

141 WEST BROADWAY
PATERSON NJ
07522
US

V. Phone/Fax

Practice location:
  • Phone: 973-904-3404
  • Fax: 973-720-8411
Mailing address:
  • Phone: 973-904-3404
  • Fax: 973-720-8411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00683100
License Number StateNJ

VIII. Authorized Official

Name: GAURAV MAHATMA
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 973-904-3404