Provider Demographics
NPI:1205191137
Name:GALLOWAY, ROBERT KNOX III
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KNOX
Last Name:GALLOWAY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6502
Mailing Address - Country:US
Mailing Address - Phone:615-451-3044
Mailing Address - Fax:
Practice Address - Street 1:1208 CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6502
Practice Address - Country:US
Practice Address - Phone:615-451-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist