Provider Demographics
NPI:1538603022
Name:TOMALLO, ANGELINA ROSE (PHARM D, RPH)
Entity type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:ROSE
Last Name:TOMALLO
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26800 WOODMONT DR
Mailing Address - Street 2:APT 13
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7277
Mailing Address - Country:US
Mailing Address - Phone:440-220-2762
Mailing Address - Fax:
Practice Address - Street 1:105 W AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-1410
Practice Address - Country:US
Practice Address - Phone:419-825-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03236549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist