Provider Demographics
NPI:1730169277
Name:GALLEVO, MYRAFLOR MAGADIA
Entity type:Individual
Prefix:
First Name:MYRAFLOR
Middle Name:MAGADIA
Last Name:GALLEVO
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 1:11831 SE 229TH PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3721
Mailing Address - Country:US
Mailing Address - Phone:253-850-6107
Mailing Address - Fax:
Practice Address - Street 1:14277 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4124
Practice Address - Country:US
Practice Address - Phone:206-431-9652
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00053312183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician