Provider Demographics
NPI:1003197500
Name:PALLO, MATTHEW JASON (PHAMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JASON
Last Name:PALLO
Suffix:
Gender:M
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1769 E SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4098
Mailing Address - Country:US
Mailing Address - Phone:216-224-1379
Mailing Address - Fax:216-595-1508
Practice Address - Street 1:25221 MILES RD
Practice Address - Street 2:SUITE #H
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5474
Practice Address - Country:US
Practice Address - Phone:216-224-1379
Practice Address - Fax:216-595-1508
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225434183500000X
PARP440990183500000X
IL051.291800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist