Provider Demographics
NPI:1154417574
Name:GALLUS, KAREN THERESA (PHARMD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:THERESA
Last Name:GALLUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:THERESA
Other - Last Name:KOTTSCHADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4769 PEBBLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8462
Mailing Address - Country:US
Mailing Address - Phone:612-747-1693
Mailing Address - Fax:
Practice Address - Street 1:4801 VETERANS DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2015
Practice Address - Country:US
Practice Address - Phone:320-252-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118267-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist