Active NPI
Ethan Bernard Gallery, RPH
- Pharmacist
- Waco, TX
National Provider Identifier
1457519811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 39207
- Practice address
- 4800 Memorial Dr
Attn: Pharmacy
Waco, TX 76711-1329 - Phone
- (254) 752-6581
- NPI assigned
- Jun 1, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 39207 | TX | Primary |
| Pharmacist | 183500000X | 03-3-21918 | OH |
Addresses
Primary practice location
4800 Memorial Dr
Attn: Pharmacy
Waco, TX 76711-1329
Mailing address
4800 Memorial Dr
Attn: Pharmacy
Waco, TX 76711-1329
Phone (254) 752-6581
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39207 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212278400000",
"number": "1457519811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4800 MEMORIAL DR",
"address_2": "ATTN: PHARMACY",
"city": "WACO",
"state": "TX",
"postal_code": "767111329",
"telephone_number": "254-752-6581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 MEMORIAL DR",
"address_2": "ATTN: PHARMACY",
"city": "WACO",
"state": "TX",
"postal_code": "767111329",
"telephone_number": "254-752-6581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLERY",
"first_name": "ETHAN",
"middle_name": "BERNARD",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-01",
"last_updated": "2008-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "39207",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03-3-21918",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.