Provider Demographics
NPI:1740554138
Name:GALLOWAY, LUCY
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 OLD GLENN HWY
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7565
Mailing Address - Country:US
Mailing Address - Phone:907-689-4033
Mailing Address - Fax:
Practice Address - Street 1:13401 OLD GLENN HWY
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7565
Practice Address - Country:US
Practice Address - Phone:907-689-4033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1527183500000X
WAPH 00055607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist