Organization
GATEWAY PHARMACY
Active
Other names
GATEWAY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA DEAN RPH (REGISTERED PHARMACIST)
(618) 877-5032
Entity
Organization
Contact information
Practice address
2044 MADISON AVE, STE 4, GRANITE CITY, IL 62040-4641
(618) 877-5032
(618) 877-0540
Mailing address
2044 MADISON AVE, STE 4, GRANITE CITY, IL 62040-4641
(618) 877-5032
(618) 877-0540
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054014700
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1462352
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/07/2006
Last updated
10/18/2010
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