Active NPI
Brenna Gallivan
- Pharmacist
- Buffalo, NY
National Provider Identifier
1376130245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- I067202
- Practice address
- 360 Dingens St
Buffalo, NY 14206-2319 - Phone
- (716) 824-1721
- NPI assigned
- Dec 28, 2020
- Last updated
- Dec 28, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | I067202 | NY | Primary |
Addresses
Primary practice location
360 Dingens St
Buffalo, NY 14206-2319
Mailing address
279 North St Apt 104
Buffalo, NY 14201-1336
Phone (716) 863-6245
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I067202 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Albany LLC | Past | Accepting new patients | |
| CVS Albany LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609113600000",
"number": "1376130245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "279 NORTH ST APT 104",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142011336",
"telephone_number": "716-863-6245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 DINGENS ST",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142062319",
"telephone_number": "716-824-1721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLIVAN",
"first_name": "BRENNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-28",
"last_updated": "2020-12-28",
"certification_date": "2020-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "I067202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.