Provider Demographics
NPI:1740370725
Name:GASTON HEALTH ASSOCIATES INC
Entity type:Organization
Organization Name:GASTON HEALTH ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:803-939-8489
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-0310
Mailing Address - Country:US
Mailing Address - Phone:803-939-8489
Mailing Address - Fax:
Practice Address - Street 1:1118 MACK ST
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053
Practice Address - Country:US
Practice Address - Phone:803-939-8489
Practice Address - Fax:803-939-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50008011333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4225543OtherOTHER ID NUMBER-COMMERCIAL NUMBER
SC780118Medicaid
SC5381120001Medicare NSC