Healthcare Provider Details

I. General information

NPI: 1427376912
Provider Name (Legal Business Name): JENIFER JO GALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 3RD ST
CALIFORNIA PA
15419-1105
US

IV. Provider business mailing address

430 W SPRING GROVE BLVD
BELLE VERNON PA
15012-3620
US

V. Phone/Fax

Practice location:
  • Phone: 724-938-3515
  • Fax:
Mailing address:
  • Phone: 724-880-5894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP440293
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: