Provider Demographics
NPI:1457786071
Name:NORTHGATE OF THE SHOALS, INC
Entity Type:Organization
Organization Name:NORTHGATE OF THE SHOALS, INC
Other - Org Name:NORTHGATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:IRONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-766-1224
Mailing Address - Street 1:3522 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-1339
Mailing Address - Country:US
Mailing Address - Phone:256-766-1224
Mailing Address - Fax:256-766-1235
Practice Address - Street 1:3522 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1339
Practice Address - Country:US
Practice Address - Phone:256-766-1224
Practice Address - Fax:256-766-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1142023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142082OtherPK