Provider Demographics
NPI:1730834540
Name:GATEWAY APOTHECARY 3960, LLC
Entity type:Organization
Organization Name:GATEWAY APOTHECARY 3960, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-381-1818
Mailing Address - Street 1:4473 FOREST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2211
Mailing Address - Country:US
Mailing Address - Phone:314-381-1818
Mailing Address - Fax:
Practice Address - Street 1:3960 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3204
Practice Address - Country:US
Practice Address - Phone:314-381-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY APOTHECARY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy