MEDICARE: KACIE GALLO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP455053	PA

General Provider Information

NPI Number	:	1760080147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KACIE GALLO PHARMD

Provider Business Mailing Address
First Line	:	1559 VIOLA PIKE
Second Line	:
City	:	SMITHMILL
State	:	PA
Zip	:	16680
Country	:	US
Telephone Number	:	814-592-1496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 LOGAN AVE
Second Line	:
City	:	TYRONE
State	:	PA
Zip	:	16686-1638
Country	:	US
Telephone Number	:	814-684-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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Directions to “ KACIE GALLO PHARMD” Practice Location

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