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General NPI Number Information
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NPI Number | 1053550020
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Entity Type | Organization
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Legal Business Name | GATEWAY PRESCRIPTION CENTER INC
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 1465 W US HIGHWAY 90 SUITE 115
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City | LAKE CITY
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State | FL
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Zip | 32055-6123
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Country | US
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Telephone | 386-755-2233
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Fax | 386-752-6721
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Provider Business Mailing Address
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Address Line | 780 SE BAYA DR
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City | LAKE CITY
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State | FL
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Zip | 32025-5403
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Country | US
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Telephone | 386-719-9952
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Fax | 386-438-5421
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Authorized Official
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Title or Position | TREASURER/SECRETARY
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Name | JOAN ALLISON
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Credential |
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Telephone | 386-719-9952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH23754
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License Number State | FL
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