Provider Demographics
NPI:1427474881
Name:GALLOWAY SANDS, LLC
Entity type:Organization
Organization Name:GALLOWAY SANDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABHIJITKUMAR
Authorized Official - Middle Name:MA
Authorized Official - Last Name:CHAUHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-754-7200
Mailing Address - Street 1:58 PHYSICIANS DR
Mailing Address - Street 2:SUITE 5 (PO BOX 769)
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4215
Mailing Address - Country:US
Mailing Address - Phone:910-754-7200
Mailing Address - Fax:910-754-7555
Practice Address - Street 1:58 PHYSICIANS DR
Practice Address - Street 2:SUITE #5
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4215
Practice Address - Country:US
Practice Address - Phone:910-754-7200
Practice Address - Fax:910-754-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC092863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0105470Medicaid