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NPI Code Detail

MEDICARE: PAUL GALLAGHER

MEDICARE: PAUL GALLAGHER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist051038845IL

General Provider Information

NPI Number : 1306121843
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL GALLAGHER
Provider Business Mailing Address
First Line : 1909 HARVEST LN
Second Line :
City : PLAINFIELD
State : IL
Zip : 60586-6404
Country : US
Telephone Number : 815-254-6980
Fax Number :
Provider Business Practice Location Address
First Line : 5435 S KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-2642
Country : US
Telephone Number : 773-436-7396
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2011
Last Update Date : 10/17/2011

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