MEDICARE: GATEWAY RX, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist		MO

General Provider Information

NPI Number	:	1518028554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY RX, LLC

Provider Business Mailing Address
First Line	:	2063 CONCOURSE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2063 CONCOURSE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4118
Country	:	US
Telephone Number	:	314-373-1111
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	CLIF LAPLANTE
Credential	:
Telephone Number	:	314-373-1111

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	11/15/2007

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Directions to “GATEWAY RX, LLC ” Practice Location

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