Provider Demographics
NPI:1497847776
Name:GATEWAY PHARMACY LLC
Entity Type:Organization
Organization Name:GATEWAY PHARMACY LLC
Other - Org Name:GATEWAY HEALTH MART PHARMACY MANDAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:AURIT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-667-1843
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:701-667-1843
Mailing Address - Fax:
Practice Address - Street 1:500 BURLINGTON ST SE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-4281
Practice Address - Country:US
Practice Address - Phone:701-667-1843
Practice Address - Fax:701-667-4352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336S0011X
ND3473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN711223OtherMEDICARE IMMUNIZATIONS
ND3503821OtherNCPDP NUMBER
SD8534070Medicaid
ND1455426Medicaid
NDN711223OtherMEDICARE IMMUNIZATIONS
SD8534070Medicaid