Provider Demographics
NPI:1033718317
Name:ROCKVEGAS ENTERPRISES INC DBA GATEWAY PHARMACY
Entity Type:Organization
Organization Name:ROCKVEGAS ENTERPRISES INC DBA GATEWAY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUNSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-566-1909
Mailing Address - Street 1:106 ADMINISTRATION RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6954
Mailing Address - Country:US
Mailing Address - Phone:865-483-8429
Mailing Address - Fax:865-483-7070
Practice Address - Street 1:524 N GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854-2353
Practice Address - Country:US
Practice Address - Phone:865-566-1909
Practice Address - Fax:865-483-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy