Healthcare Provider Details

I. General information

NPI: 1114009685
Provider Name (Legal Business Name): GALENS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SODUS ST
CLYDE NY
14433-1215
US

IV. Provider business mailing address

17 SODUS ST
CLYDE NY
14433-1215
US

V. Phone/Fax

Practice location:
  • Phone: 315-923-2651
  • Fax:
Mailing address:
  • Phone: 315-923-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number17327
License Number StateNY

VIII. Authorized Official

Name: ROBERT MONTEMORANO
Title or Position: PRESIDENT
Credential: RPH.
Phone: 315-923-2651