Provider Demographics
NPI:1063811198
Name:GALLO, REBECCA
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:GALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12830 SW 116TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4734
Mailing Address - Country:US
Mailing Address - Phone:305-431-4807
Mailing Address - Fax:
Practice Address - Street 1:11650 MIRAMAR PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5823
Practice Address - Country:US
Practice Address - Phone:954-378-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist