Healthcare Provider Details

I. General information

NPI: 1760465017
Provider Name (Legal Business Name): PATRICK JULIAN GALLEGOS PHAMR.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WABASH AVE
AKRON OH
44307-2433
US

IV. Provider business mailing address

5638 NICHOLSON DR
HUDSON OH
44236-3765
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6614
  • Fax: 330-996-2395
Mailing address:
  • Phone: 330-653-9577
  • Fax: 330-325-5930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number42401
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-1-27622
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: