Provider Demographics
NPI:1770648560
Name:GATEWAY DISCOUNT DRUGS, INC.
Entity Type:Organization
Organization Name:GATEWAY DISCOUNT DRUGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:COONS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-489-2572
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:26289 HWY 195
Mailing Address - City:DOUBLE SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:35553-0486
Mailing Address - Country:US
Mailing Address - Phone:205-489-2572
Mailing Address - Fax:205-489-3722
Practice Address - Street 1:26289 HWY 195
Practice Address - Street 2:
Practice Address - City:DOUBLE SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:35553-0486
Practice Address - Country:US
Practice Address - Phone:205-489-2572
Practice Address - Fax:205-489-3722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1043303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0115205OtherNABP NUMBER
ALAL104330OtherPHARMACY LICENSE