MEDICARE: GATEWAY PHARMACY LLC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0004X	Compounding Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336C0003X	Community/Retail Pharmacy	91	ND

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N711223	OTHER	ND	MEDICARE IMMUNIZATIONS
5	P00067831	OTHER	ND	PALMETTO RAILROAD MEDICARE IMMUNIZATIONS

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3503213	OTHER	ND	NCPDP NUMBER

NPI Number	:	1447356399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 994
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58502-0994
Country	:	US
Telephone Number	:	701-224-9521
Fax Number	:	701-224-1360

Provider Business Practice Location Address
First Line	:	3101 N 11TH ST
Second Line	:	SUITE#2
City	:	BISMARCK
State	:	ND
Zip	:	58503-0594
Country	:	US
Telephone Number	:	701-224-9521
Fax Number	:	701-224-1360

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK ANTHONY AURIT
Credential	:	RPH
Telephone Number	:	701-224-9521

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	06/24/2025