1770792343 NPI number — DR. ALAN KEITH GALLOWAY PHARM. D.

Table of content: DR. ALAN KEITH GALLOWAY PHARM. D. (NPI 1770792343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770792343 NPI number — DR. ALAN KEITH GALLOWAY PHARM. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLOWAY
Provider First Name:
ALAN
Provider Middle Name:
KEITH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770792343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
398 SAINT JOHNS GOLF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32092-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-827-9493
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3728 PHILLIPS HWY
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-9300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-398-5440
Provider Business Practice Location Address Fax Number:
904-398-5737
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  2730 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1835N0905X , with the licence number: NP116 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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