Provider Demographics
NPI:1417688318
Name:GATEWOOD, MAGGIE ANN
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ANN
Last Name:GATEWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44688-9438
Mailing Address - Country:US
Mailing Address - Phone:330-730-2134
Mailing Address - Fax:
Practice Address - Street 1:8619 WAYNESBURG DR SE
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:OH
Practice Address - Zip Code:44688-9549
Practice Address - Country:US
Practice Address - Phone:330-866-5020
Practice Address - Fax:330-866-9096
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09201241183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty