Gallos Live Well Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS00388100 Issued in NJ

Legal business name

GALLOS LIVE WELL PHARMACY INC

Practice address

192 Rochelle Ave
Rochelle Park, NJ 07662-4111

Phone

(201) 843-1350

Fax

(201) 843-2455

NPI assigned

Sep 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joseph Kubulak

Title

President

Phone

(201) 843-1350

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Gallo's Health Mart Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nadya Forgacz, R.PH

  • Pharmacist
  • Rochelle Park, NJ
  • NPI 1386780385
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1861599797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "192 ROCHELLE AVE",
            "city": "ROCHELLE PARK",
            "state": "NJ",
            "postal_code": "076624111",
            "telephone_number": "201-843-1350",
            "fax_number": "201-843-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "192 ROCHELLE AVE",
            "city": "ROCHELLE PARK",
            "state": "NJ",
            "postal_code": "076624111",
            "telephone_number": "201-843-1350",
            "fax_number": "201-843-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLOS LIVE WELL PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "KUBULAK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-843-1350"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "28RS00388100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2122854",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0235351",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gallo's Health Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Five Towns Pharmacy LLC
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• Fordham-Lewis Consulting, LLC
• Nadya Forgacz, R.PH
• Functionalmax Customized Physical Therapy
• Generations Counseling & Care Management LLC
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• Genpsych Rochelle Park
• Paraskevi Georgiou
• Christine Gibbons, M.S., C.A.

• Community/Retail Pharmacy in Rochelle Park, NJ
• Providers in Rochelle Park, NJ by specialty
• Community/Retail Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.