MEDICARE: MRS. SARAH DYE GALLANT PHARMD

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
1	183500000X	Pharmacist	RPH023213	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH023213	OTHER	GA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1972649606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH DYE GALLANT PHARMD

Provider Business Mailing Address
First Line	:	2450 HAWTHORNE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2038
Country	:	US
Telephone Number	:	770-939-3669
Fax Number	:

Provider Business Practice Location Address
First Line	:	2175 PARKLAKE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2809
Country	:	US
Telephone Number	:	770-496-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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