MEDICARE: GATEWAY PHARMACY GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	P06785	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2034003	OTHER		PK

General Provider Information

NPI Number	:	1093878613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY PHARMACY GROUP LLC

Provider Business Mailing Address
First Line	:	125 FOXGLOVE DR
Second Line	:
City	:	MT STERLING
State	:	KY
Zip	:	40353-9735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 W MAIN ST
Second Line	:
City	:	CARLISLE
State	:	KY
Zip	:	40311-1129
Country	:	US
Telephone Number	:	859-289-8501
Fax Number	:	859-289-8004

Authorized Official
Title or Position	:	OWNER
Name	:	JERRY BARNETTE
Credential	:	RPH
Telephone Number	:	859-289-8501

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	05/24/2017

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Directions to “GATEWAY PHARMACY GROUP LLC ” Practice Location

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