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NPI Code Detail

MEDICARE: GERSON GAMALIEL GALICIA PEREZ RPH

MEDICARE: GERSON GAMALIEL GALICIA PEREZ RPH
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
1183500000XPharmacist051305414IL

General Provider Information

NPI Number : 1427751940
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERSON GAMALIEL GALICIA PEREZ RPH
Provider Business Mailing Address
First Line : 4466 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5660
Country : US
Telephone Number : 773-596-2377
Fax Number :
Provider Business Practice Location Address
First Line : 4466 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5660
Country : US
Telephone Number : 773-596-2377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2023
Last Update Date : 03/23/2023

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Directions to “ GERSON GAMALIEL GALICIA PEREZ RPH” Practice Location

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