Healthcare Provider Details

I. General information

NPI: 1841278710
Provider Name (Legal Business Name): MARY LORRAINE GALLAGHER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BRIDGEPORT WAY W SUITE D
UNIVERSITY PLACE WA
98466-4600
US

IV. Provider business mailing address

2700 BRIDGEPORT WAY W SUITE D
UNIVERSITY PLACE WA
98466-4600
US

V. Phone/Fax

Practice location:
  • Phone: 253-460-1879
  • Fax: 253-564-1412
Mailing address:
  • Phone: 253-460-1879
  • Fax: 253-564-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH0017315
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: