Provider Demographics
NPI:1205203874
Name:SOUTH GATE PHARMACY INC
Entity Type:Organization
Organization Name:SOUTH GATE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:DHANJIBHAI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-537-2837
Mailing Address - Street 1:8200 LONG BEACH BLVD UNIT D-2
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2057
Mailing Address - Country:US
Mailing Address - Phone:323-537-2837
Mailing Address - Fax:323-537-4940
Practice Address - Street 1:8200 LONG BEACH BLVD
Practice Address - Street 2:UNIT D-2
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2057
Practice Address - Country:US
Practice Address - Phone:323-537-2837
Practice Address - Fax:323-537-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-29
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
CA536423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY58563OtherBOARD OF PHARMACY
2153845OtherPK
7470820001Medicare NSC