Provider Demographics
NPI:1801272943
Name:GAETANO, ALLIE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:GAETANO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S RECKER RD
Mailing Address - Street 2:APT 1019
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1206
Mailing Address - Country:US
Mailing Address - Phone:724-787-9300
Mailing Address - Fax:
Practice Address - Street 1:455 S RECKER RD
Practice Address - Street 2:APT 1019
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1206
Practice Address - Country:US
Practice Address - Phone:724-787-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist