Provider Demographics
NPI:1134412000
Name:MERIDIAN PHARAMCY GROUP AT GALLOWAY, INC
Entity type:Organization
Organization Name:MERIDIAN PHARAMCY GROUP AT GALLOWAY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-765-9238
Mailing Address - Street 1:PO BOX 181523
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76096-1523
Mailing Address - Country:US
Mailing Address - Phone:214-951-0133
Mailing Address - Fax:214-951-0155
Practice Address - Street 1:2698 N GALLOWAY AVE STE 108
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6390
Practice Address - Country:US
Practice Address - Phone:972-686-3999
Practice Address - Fax:972-686-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5903237OtherNCPDP PROVIDER IDENTIFICATION NUMBER