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Organization
GALLOS LIVE WELL PHARMACY INC
Active
Organization
GALLOS LIVE WELL PHARMACY INC
Active
Other names
Gallo's Health Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH KUBULAK (PRESIDENT)
(201) 843-1350
Entity
Organization
Contact information
Practice address
192 ROCHELLE AVE, ROCHELLE PARK, NJ 07662-4111
(201) 843-1350
(201) 843-2455
Mailing address
192 ROCHELLE AVE, ROCHELLE PARK, NJ 07662-4111
(201) 843-1350
(201) 843-2455
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
28RS00388100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0235351
—
NJ
01
—
2122854
PK
—
Enumeration date
09/20/2006
Last updated
11/16/2016
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