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General NPI Number Information
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NPI Number | 1306121843
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Entity Type | Individual
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Provider Name | PAUL GALLAGHER
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Gender | Male
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 5435 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60632-2642
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Country | US
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Telephone | 773-436-7396
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Fax |
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Provider Business Mailing Address
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Address Line | 1909 HARVEST LN
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City | PLAINFIELD
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State | IL
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Zip | 60586-6404
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Country | US
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Telephone | 815-254-6980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 051038845
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License Number State | IL
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