Healthcare Provider Details

I. General information

NPI: 1689817702
Provider Name (Legal Business Name): JOHN D. GALLE PHARMD, MBA, BCPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BRELLINGER ST
COLUMBIA IL
62236-3815
US

IV. Provider business mailing address

5314 VALLARTA DR
SAINT LOUIS MO
63128-3516
US

V. Phone/Fax

Practice location:
  • Phone: 618-708-0727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2007023994
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH.03234119-2
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number017850
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number051.292388
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number2007023994
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.292388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: