Provider Demographics
NPI:1760506562
Name:ZINTNER-GALLOWAY, SUSAN (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ZINTNER-GALLOWAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-9571
Mailing Address - Country:US
Mailing Address - Phone:856-478-0504
Mailing Address - Fax:
Practice Address - Street 1:108 SWEDESBORO RD
Practice Address - Street 2:SUITE 20
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1800
Practice Address - Country:US
Practice Address - Phone:856-223-0177
Practice Address - Fax:856-223-0168
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02042100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist