Provider Demographics
NPI:1982619508
Name:GATEWAY PHARMACY OF MONROE CITY
Entity Type:Organization
Organization Name:GATEWAY PHARMACY OF MONROE CITY
Other - Org Name:GATEWAY PHARMACY OF MONROE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-735-4880
Mailing Address - Street 1:1110 HIGHWAY 24/36 E SUITE 28
Mailing Address - Street 2:
Mailing Address - City:MONROE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63456
Mailing Address - Country:US
Mailing Address - Phone:573-735-4880
Mailing Address - Fax:573-735-4831
Practice Address - Street 1:1110 HIGHWAY 24/36 E SUITE 28
Practice Address - Street 2:
Practice Address - City:MONROE CITY
Practice Address - State:MO
Practice Address - Zip Code:63456
Practice Address - Country:US
Practice Address - Phone:573-735-4880
Practice Address - Fax:573-735-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MO0047003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2050879OtherPK
MO602365306Medicaid
2050879OtherPK