Basic Information
| Provider Information | |||||||||
| NPI: | 1306288063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLOWAY | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2199 HIGHWAY 36 E | ||||||||
| Address2: | TARGET PHARMACY T-1185 | ||||||||
| City: | NORTH ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551092215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517796341 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2199 HIGHWAY 36 E | ||||||||
| Address2: | TARGET PHARMACY T-1185 | ||||||||
| City: | NORTH ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551092215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517796341 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2013 | ||||||||
| LastUpdateDate: | 07/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 121319 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.