Provider Demographics
NPI:1447356399
Name:GATEWAY PHARMACY LLC
Entity type:Organization
Organization Name:GATEWAY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:AURIT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-224-9521
Mailing Address - Street 1:PO BOX 994
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-0994
Mailing Address - Country:US
Mailing Address - Phone:701-224-9521
Mailing Address - Fax:701-224-1360
Practice Address - Street 1:3101 N 11TH ST
Practice Address - Street 2:SUITE#2
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0594
Practice Address - Country:US
Practice Address - Phone:701-224-9521
Practice Address - Fax:701-224-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336S0011X
ND913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455412Medicaid
ND3503213OtherNCPDP NUMBER
SD8533870Medicaid
NDN711223OtherMEDICARE IMMUNIZATIONS
NDP00067831OtherPALMETTO RAILROAD MEDICARE IMMUNIZATIONS
ND1455412Medicaid
NDP00067831Medicare PIN