Provider Demographics
NPI:1659722833
Name:GALLO, EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GALLO
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 1:777 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2508
Mailing Address - Country:US
Mailing Address - Phone:831-710-2242
Mailing Address - Fax:831-655-1147
Practice Address - Street 1:686 LIGHTHOUSE AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1008
Practice Address - Country:US
Practice Address - Phone:831-655-5411
Practice Address - Fax:831-655-1147
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist