Basic Information
| Provider Information | |||||||||
| NPI: | 1538239868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLMAN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | RPH, DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3705 W 15TH ST | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750757753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728673577 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3705 W 15TH ST | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750757753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728673577 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835X0200X | 21337 | TX | Y | Pharmacy Service Providers | Pharmacist | Oncology |
ID Information
| ID | Type | State | Issuer | Description | 320213 | 05 | TX | MEDICAID |