Provider Demographics
NPI:1013511740
Name:GALLUZZO, JORDAN MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHAEL
Last Name:GALLUZZO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:MICHAEL
Other - Last Name:KEYSOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6341 PARKMAN PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-1123
Mailing Address - Country:US
Mailing Address - Phone:740-816-9563
Mailing Address - Fax:
Practice Address - Street 1:8215 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-3922
Practice Address - Country:US
Practice Address - Phone:513-741-4646
Practice Address - Fax:513-741-4474
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist