Provider Demographics
NPI:1427249861
Name:VIALL, GARY D (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:VIALL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2117
Mailing Address - Country:US
Mailing Address - Phone:508-822-7435
Mailing Address - Fax:
Practice Address - Street 1:390 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2311
Practice Address - Country:US
Practice Address - Phone:800-344-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194381835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric