Provider Demographics
NPI:1760496079
Name:GALLOWAY PHARMACY INC
Entity Type:Organization
Organization Name:GALLOWAY PHARMACY INC
Other - Org Name:GALLOWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-270-5600
Mailing Address - Street 1:PO BOX 451269
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-1269
Mailing Address - Country:US
Mailing Address - Phone:214-403-5433
Mailing Address - Fax:972-270-0560
Practice Address - Street 1:2698 N GALLOWAY AVE
Practice Address - Street 2:STE 109
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6383
Practice Address - Country:US
Practice Address - Phone:972-270-5600
Practice Address - Fax:972-270-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145701Medicaid
4541961OtherNCPDP PROVIDER IDENTIFICATION NUMBER