Provider Demographics
NPI:1740203413
Name:GASTON ENTERPRISES INC
Entity Type:Organization
Organization Name:GASTON ENTERPRISES INC
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:THROWER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-867-5343
Mailing Address - Street 1:515 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0628
Mailing Address - Country:US
Mailing Address - Phone:704-867-5343
Mailing Address - Fax:704-864-1499
Practice Address - Street 1:515 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0628
Practice Address - Country:US
Practice Address - Phone:704-867-5343
Practice Address - Fax:704-864-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC036793336C0003X, 3336C0003X
3336C0004X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0365528Medicaid
2068382OtherPK
0409030001Medicare NSC