MEDICARE: DR. ISAAC JOHN GALLI 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	03337239	OH
2	183500000X	Pharmacist	I11895	KY
3	183500000X	Pharmacist	2018024637	MO

General Provider Information

NPI Number	:	1225511025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISAAC JOHN GALLI PHARMD

Provider Business Mailing Address
First Line	:	2628 RENWICK WAY
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-9258
Country	:	US
Telephone Number	:	937-573-6536
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 CORPORATE LAKE DR STE B
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-7290
Country	:	US
Telephone Number	:	573-256-4279
Fax Number	:	573-442-6429

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

Provider Enumeration Date	:	09/08/2018
Last Update Date	:	09/08/2018

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