Individual
BRENNA GALLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
360 DINGENS ST, BUFFALO, NY 14206-2319
(716) 824-1721
Mailing address
279 NORTH ST APT 104, BUFFALO, NY 14201-1336
(716) 863-6245
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
I067202
NY
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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