Provider Demographics
NPI:1366488389
Name:GALLOWAY SANDS LLC
Entity Type:Organization
Organization Name:GALLOWAY SANDS LLC
Other - Org Name:GALLOWAY SANDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-233-8070
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-0769
Mailing Address - Country:US
Mailing Address - Phone:910-754-7200
Mailing Address - Fax:910-754-7555
Practice Address - Street 1:58 PHYSICIANS DR NW
Practice Address - Street 2:STE 5
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4215
Practice Address - Country:US
Practice Address - Phone:910-754-7200
Practice Address - Fax:910-754-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC092863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0105470Medicaid
2065782OtherPK
5704350001Medicare NSC