=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952647919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIRSTEN GALLO PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2012
-----------------------------------------------------
Last Update Date | 06/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 INDUSTRIAL WAY E STE 6
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 848-245-8950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 228 STRAWBRIDGE DR
-----------------------------------------------------
City | MOORESTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08057-4600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-298-0069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI03366500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------