Provider Demographics
NPI:1164981510
Name:GATEWOOD PHARMACY PLLC
Entity Type:Organization
Organization Name:GATEWOOD PHARMACY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:OLADIMEJI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:347-593-5918
Mailing Address - Street 1:4026 CARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2110
Mailing Address - Country:US
Mailing Address - Phone:347-593-5918
Mailing Address - Fax:
Practice Address - Street 1:4402 BROADWAY BLVD STE 6A
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-8266
Practice Address - Country:US
Practice Address - Phone:347-593-5918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy