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General NPI Number Information
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NPI Number | 1063885747
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Entity Type | Organization
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Legal Business Name | GATEWAY
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 421 E DRACHMAN ST
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City | TUCSON
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State | AZ
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Zip | 85705-7445
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Country | US
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Telephone | 321-321-3213
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Fax |
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Provider Business Mailing Address
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Address Line | TEST
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City | AHMEDBAD
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State | INDIA
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Zip | 480428
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Country | IN
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TEST
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Name | MR. TEST TEST TEST
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Credential |
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Telephone | 222-222-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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