Provider Demographics
NPI:1629279377
Name:GASTON HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:GASTON HEALTH ASSOCIATES
Other - Org Name:GASTON FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-939-8489
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:1118 MACK ST
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-0000
Mailing Address - Country:US
Mailing Address - Phone:803-939-8489
Mailing Address - Fax:803-939-8492
Practice Address - Street 1:1118 MACK ST
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-0000
Practice Address - Country:US
Practice Address - Phone:803-939-8489
Practice Address - Fax:803-939-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDE2541332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2541Medicaid