Provider Demographics
NPI:1366535791
Name:HARRICO-GALLER DRUG CORPORATION
Entity type:Organization
Organization Name:HARRICO-GALLER DRUG CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-377-7724
Mailing Address - Street 1:1374 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4120
Mailing Address - Country:US
Mailing Address - Phone:718-377-7724
Mailing Address - Fax:718-377-1675
Practice Address - Street 1:1374 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4120
Practice Address - Country:US
Practice Address - Phone:718-377-7724
Practice Address - Fax:718-377-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0019493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00265105Medicaid
2058005OtherPK
0308240001Medicare NSC