# GATEWAY PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GATEWAY PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427020999
- **Authorized official:** PAMELA DEAN RPH (REGISTERED PHARMACIST)
- **Authorized official phone:** (618) 877-5032

## Contact information

- **Practice address:** 2044 MADISON AVE, STE 4, GRANITE CITY, IL 62040-4641
- **Practice address phone:** (618) 877-5032
- **Practice address fax:** (618) 877-0540
- **Mailing address:** 2044 MADISON AVE, STE 4, GRANITE CITY, IL 62040-4641
- **Mailing address phone:** (618) 877-5032
- **Mailing address fax:** (618) 877-0540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054014700 | IL | Yes |

## Other

- **Enumeration date:** 02/07/2006
- **Last updated:** 10/18/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1462352 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |