Healthcare Provider Details

I. General information

NPI: 1881932465
Provider Name (Legal Business Name): GATEWAY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GATEWAY CTR
NEWARK NJ
07102-5310
US

IV. Provider business mailing address

1 GATEWAY CTR
NEWARK NJ
07102-5310
US

V. Phone/Fax

Practice location:
  • Phone: 973-732-6900
  • Fax: 973-732-6906
Mailing address:
  • Phone: 973-732-6900
  • Fax: 973-732-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00724500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AVNER KHAIMOV
Title or Position: PRESIDENT
Credential:
Phone: 973-732-6900