Provider Demographics
NPI:1205927571
Name:GATEWAY PHARMACY LLC
Entity type:Organization
Organization Name:GATEWAY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUHRER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-204-7897
Mailing Address - Street 1:PO BOX 994
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-0994
Mailing Address - Country:US
Mailing Address - Phone:701-223-1656
Mailing Address - Fax:701-223-9628
Practice Address - Street 1:835 S WASHINGTON ST
Practice Address - Street 2:SUITE #2
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5477
Practice Address - Country:US
Practice Address - Phone:701-223-1656
Practice Address - Fax:701-223-9628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336S0011X
ND903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3503679OtherNCPDP NUMBER
SD8533860Medicaid
ND1455415Medicaid
NDN711223OtherMEDICARE IMMUNIZATIONS
NDN711223OtherMEDICARE IMMUNIZATIONS
NDN711223Medicare PIN