Provider Demographics
NPI:1144592080
Name:GATES, JOHN HOWARD (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HOWARD
Last Name:GATES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 E NEIDER AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-3723
Mailing Address - Country:US
Mailing Address - Phone:208-676-7353
Mailing Address - Fax:208-676-7379
Practice Address - Street 1:355 E NEIDER AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-3723
Practice Address - Country:US
Practice Address - Phone:208-676-7353
Practice Address - Fax:208-676-7379
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-3801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist