Healthcare Provider Details

I. General information

NPI: 1396690616
Provider Name (Legal Business Name): GANTT GALLOWAY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 ASHBY AVE
BERKELEY CA
94705-2321
US

IV. Provider business mailing address

2909 ASHBY AVE
BERKELEY CA
94705-2321
US

V. Phone/Fax

Practice location:
  • Phone: 510-459-8269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number42537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: