Provider Demographics
NPI:1770792343
Name:GALLOWAY, ALAN KEITH (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KEITH
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 SAINT JOHNS GOLF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1080
Mailing Address - Country:US
Mailing Address - Phone:904-827-9493
Mailing Address - Fax:
Practice Address - Street 1:3728 PHILLIPS HWY
Practice Address - Street 2:SUITE 220
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9300
Practice Address - Country:US
Practice Address - Phone:904-398-5440
Practice Address - Fax:904-398-5737
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2730183500000X
FLNP1161835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835N0905XPharmacy Service ProvidersPharmacistNuclear