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General NPI Number Information
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NPI Number | 1164981510
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Entity Type | Organization
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Legal Business Name | GATEWOOD PHARMACY PLLC
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 4402 BROADWAY BLVD STE 6A
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City | GARLAND
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State | TX
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Zip | 75043-8266
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Country | US
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Telephone | 347-593-5918
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Fax |
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Provider Business Mailing Address
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Address Line | 4026 CARRINGTON DR
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City | GARLAND
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State | TX
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Zip | 75043-2110
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Country | US
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Telephone | 347-593-5918
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. OLADIMEJI ROLEOLA
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Credential | RPH
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Telephone | 347-593-5918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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