Provider Demographics
NPI:1417239260
Name:GALLOWAY, BUCKY R (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:BUCKY
Middle Name:R
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 HIGHWAY 337 NW
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2028
Mailing Address - Country:US
Mailing Address - Phone:812-738-1078
Mailing Address - Fax:
Practice Address - Street 1:1716 HIGHWAY 337 NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2028
Practice Address - Country:US
Practice Address - Phone:812-738-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021440A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist