Organization
INNOVATIVE MEDS RX
Active
Other names
Gates Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD KOS (PRESIDENT)
(919) 475-8706
Entity
Organization
Contact information
Practice address
364 N SOUTH ST, MOUNT AIRY, NC 27030-3532
(336) 789-5050
(336) 786-7169
Mailing address
364 N SOUTH ST, MOUNT AIRY, NC 27030-3532
(336) 789-5050
(336) 786-7169
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11190
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3459953
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/09/2011
Last updated
07/06/2021
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