Provider Demographics
NPI:1194318642
Name:GALLAGHER, CHARLENE (R PH)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 OLD LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1250
Mailing Address - Country:US
Mailing Address - Phone:610-644-4924
Mailing Address - Fax:
Practice Address - Street 1:1196 OLD LANCASTER RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1250
Practice Address - Country:US
Practice Address - Phone:610-644-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028013L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE