Provider Demographics
NPI:1841570207
Name:GALLO, DEBORAH ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:GALLO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0751
Mailing Address - Country:US
Mailing Address - Phone:609-670-0646
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF ROUTE 12 & 7
Practice Address - Street 2:FORT DEFIANCE INDIAN HOSPITAL
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist