Provider Demographics
NPI:1861904740
Name:GAILLAS, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GAILLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 MORTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERS
Mailing Address - State:WV
Mailing Address - Zip Code:26035-1668
Mailing Address - Country:US
Mailing Address - Phone:304-479-3505
Mailing Address - Fax:
Practice Address - Street 1:4402 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3423
Practice Address - Country:US
Practice Address - Phone:740-264-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist