1629378914 NPI number — MRS. MILLICENT LANDIS GALLEGOS RPH

Table of content: MRS. MILLICENT LANDIS GALLEGOS RPH (NPI 1629378914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629378914 NPI number — MRS. MILLICENT LANDIS GALLEGOS RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLEGOS
Provider First Name:
MILLICENT
Provider Middle Name:
LANDIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629378914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11088 WEST JEWELL AVE
Provider Second Line Business Mailing Address:
SAFEWAY 2342
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-989-8812
Provider Business Mailing Address Fax Number:
303-989-6903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11088 WEST JEWELL AVE
Provider Second Line Business Practice Location Address:
SAFEWAY 2342
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-989-8812
Provider Business Practice Location Address Fax Number:
303-989-6903
Provider Enumeration Date:
11/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  13525 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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