Healthcare Provider Details

I. General information

NPI: 1700166873
Provider Name (Legal Business Name): ANDREA M PALLOTTA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE HB-105
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE HB-105
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-4789
  • Fax:
Mailing address:
  • Phone: 216-445-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03129365
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: