Provider Demographics
NPI:1063885747
Name:GATEWAY
Entity type:Organization
Organization Name:GATEWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEST
Authorized Official - Prefix:MR
Authorized Official - First Name:TEST
Authorized Official - Middle Name:TEST
Authorized Official - Last Name:TEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:222-222-2222
Mailing Address - Street 1:TEST
Mailing Address - Street 2:
Mailing Address - City:AHMEDBAD
Mailing Address - State:INDIA
Mailing Address - Zip Code:480428
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:421 E DRACHMAN ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7445
Practice Address - Country:US
Practice Address - Phone:321-321-3213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy