Provider Demographics
NPI:1366834616
Name:STALLO, CHRIS (RPH)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:STALLO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8258
Mailing Address - Country:US
Mailing Address - Phone:513-228-7370
Mailing Address - Fax:513-228-7395
Practice Address - Street 1:1425 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8258
Practice Address - Country:US
Practice Address - Phone:513-228-7370
Practice Address - Fax:513-228-7395
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist