NPIMap

Organization Active NPI

Galloway Sands LLC

  • Community/Retail Pharmacy
  • Supply, NC
National Provider Identifier
1366488389
Registry record updated Jan 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
09286 Issued in NC
Legal business name
GALLOWAY SANDS LLC
Practice address
58 Physicians Dr NW
Ste 5
Supply, NC 28462-4215
Phone
(910) 754-7200
Fax
(910) 754-7555
NPI assigned
Jun 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Abhijitkumar Ma Chauhan
Title
Co-Owner
Phone
(910) 754-7200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 09286 NC Primary

Addresses

Primary practice location

58 Physicians Dr NW
Ste 5
Supply, NC 28462-4215

Mailing address

58 Physicians Dr NW # 5
Supply, NC 28462-4215
Phone (910) 754-7200

Other identifiers 2

IdentifierTypeStateIssuer
0105470MedicaidNC
2065782OtherPK

Other names 1

  • GALLOWAY SANDS PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100930093199 NC DME Supplier - Pharmacy 7315149929 Practice locations: Supply, NC
O20111202000582 NC Part B Supplier - Mass Immunization (Roster Biller Only) 7315149929 1 other NPI on this enrollment
Practice locations: Southport, NC; Supply, NC
O20210106000724 NC Part B Supplier - Independent Clinical Laboratory 7315149929 Practice locations: Supply, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Galloway Sands LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

58 Physicians Dr NW
#5
Supply, NC 28462

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735948800000",
    "number": "1366488389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 PHYSICIANS DR NW # 5",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284624215",
            "telephone_number": "910-754-7200",
            "fax_number": "910-754-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 PHYSICIANS DR NW",
            "address_2": "STE 5",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284624215",
            "telephone_number": "910-754-7200",
            "fax_number": "910-754-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLOWAY SANDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2025-01-04",
        "certification_date": "2025-01-04",
        "status": "A",
        "authorized_official_last_name": "CHAUHAN",
        "authorized_official_first_name": "ABHIJITKUMAR",
        "authorized_official_middle_name": "MA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "910-754-7200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "09286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105470",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2065782",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GALLOWAY SANDS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Supply, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.