Healthcare Provider Details

I. General information

NPI: 1770648560
Provider Name (Legal Business Name): GATEWAY DISCOUNT DRUGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26289 HWY 195
DOUBLE SPRINGS AL
35553-0486
US

IV. Provider business mailing address

PO BOX 486 26289 HWY 195
DOUBLE SPRINGS AL
35553-0486
US

V. Phone/Fax

Practice location:
  • Phone: 205-489-2572
  • Fax: 205-489-3722
Mailing address:
  • Phone: 205-489-2572
  • Fax: 205-489-3722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number104330
License Number StateAL

VIII. Authorized Official

Name: WILLIAM A. COONS
Title or Position: PRESIDENT
Credential: RPH
Phone: 205-489-2572