Provider Demographics
NPI:1700192960
Name:GALLOWAY, AMY STANDRIDGE (RPH, COF)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:STANDRIDGE
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:RPH, COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MURPHY HWY STE B
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3157
Mailing Address - Country:US
Mailing Address - Phone:706-745-2303
Mailing Address - Fax:706-745-2333
Practice Address - Street 1:23 MURPHY HWY STE B
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3157
Practice Address - Country:US
Practice Address - Phone:706-745-2303
Practice Address - Fax:706-745-2333
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017701183500000X
TN8276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0116914Medicaid
GA00966996AMedicaid
GA4563730001Medicare NSC