Provider Demographics
NPI:1407843584
Name:GATE CITY PHARMACY INC
Entity Type:Organization
Organization Name:GATE CITY PHARMACY INC
Other - Org Name:GATE CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUYER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKERTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-292-6888
Mailing Address - Street 1:803 FRIENDLY CENTER RD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2024
Mailing Address - Country:US
Mailing Address - Phone:336-292-6888
Mailing Address - Fax:336-294-9329
Practice Address - Street 1:803 FRIENDLY CENTER RD STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2024
Practice Address - Country:US
Practice Address - Phone:336-292-6888
Practice Address - Fax:336-294-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NC104153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0415133Medicaid
NC7700707Medicaid
2122643OtherPK
NC0415133Medicaid