Provider Demographics
NPI:1154506723
Name:GALLO, SHELLEY JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:JEAN
Last Name:GALLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4969 ALFRED DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-6907
Mailing Address - Country:US
Mailing Address - Phone:315-451-7323
Mailing Address - Fax:
Practice Address - Street 1:2616 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:MATTYDALE
Practice Address - State:NY
Practice Address - Zip Code:13211-1202
Practice Address - Country:US
Practice Address - Phone:315-455-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046238-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist