Healthcare Provider Details

I. General information

NPI: 1508770595
Provider Name (Legal Business Name): GASTON MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 COURT DR
GASTONIA NC
28054-2140
US

IV. Provider business mailing address

2525 COURT DR
GASTONIA NC
28054-2140
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-4021
  • Fax:
Mailing address:
  • Phone: 704-834-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: KENNETH CHRISTOPHER PEEK
Title or Position: CEO
Credential:
Phone: 704-834-2000