Provider Demographics
NPI:1275963308
Name:GATEWAY PHARMACY LLC
Entity Type:Organization
Organization Name:GATEWAY PHARMACY LLC
Other - Org Name:GATEWAY PHARMACY SUNRISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUHRER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-204-7897
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:701-425-0789
Mailing Address - Fax:701-751-6180
Practice Address - Street 1:3103 YORKTOWN DR
Practice Address - Street 2:STE 2
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-8526
Practice Address - Country:US
Practice Address - Phone:701-425-0789
Practice Address - Fax:701-751-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0074013336C0003X, 3336C0003X
SD400-17043336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1452328Medicaid
NDN711223OtherMEDICARE IMMUNIZATIONS
ND3504950OtherNCPDP NUMBER
ND3504950OtherNCPDP NUMBER