Provider Demographics
NPI:1275299067
Name:GALVAN, JOSE ABEL
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ABEL
Last Name:GALVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 BANTAM RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-5443
Mailing Address - Country:US
Mailing Address - Phone:417-593-4150
Mailing Address - Fax:
Practice Address - Street 1:105 LOYD ST
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2900
Practice Address - Country:US
Practice Address - Phone:417-593-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021028572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist