Organization
GOWYN INC
Active
Other names
OPEN GATE PHARMACY 1
Organization subpart
No
Provider details
NPI number
Authorized official
MOJISOLA EVBUOMWAN PHARMD (OWNER)
(706) 323-0306
Entity
Organization
Contact information
Practice address
2051 10TH AVE, COLUMBUS, GA 31901-1459
(706) 323-0306
(706) 327-3824
Mailing address
2051 10TH AVE, COLUMBUS, GA 31901-1459
(706) 323-0306
(706) 327-3824
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009915
GA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00479806A
—
GA
01
—
2140755
PK
—
Enumeration date
06/11/2007
Last updated
05/04/2016
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