Basic Information
| Provider Information | |||||||||
| NPI: | 1972649606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLANT | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | DYE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 HAWTHORNE DR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303452038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709393669 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2175 PARKLAKE DR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303452809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704967400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH023213 | GA | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | RPH023213 | 01 | GA | STATE LICENSE NUMBER | OTHER |