Provider Demographics
NPI:1447627765
Name:AGALLIU, INDRIT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:INDRIT
Middle Name:
Last Name:AGALLIU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-6020
Mailing Address - Country:US
Mailing Address - Phone:734-767-7777
Mailing Address - Fax:734-822-0327
Practice Address - Street 1:2329 EUREKA RD
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-6020
Practice Address - Country:US
Practice Address - Phone:734-767-7777
Practice Address - Fax:734-822-0327
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist