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
—
—
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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