NPIMap

Organization Active NPI

Innovative Meds RX

Doing business as Gates Pharmacy

  • Community/Retail Pharmacy
  • Mount Airy, NC
National Provider Identifier
1700154366
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
11190 Issued in NC
Legal business name
INNOVATIVE MEDS RX
Doing business as
Gates Pharmacy
Practice address
364 N South St
Mount Airy, NC 27030-3532
Phone
(336) 789-5050
Fax
(336) 786-7169
NPI assigned
Dec 9, 2011
Last updated
Jul 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard Kos
Title
President
Phone
(919) 475-8706

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diabetes Educator Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WD0400X
Medical Specialty Clinic/Center 261QM2500X
Community/Retail Pharmacy 3336C0003X 11190 NC Primary

Addresses

Primary practice location

364 N South St
Mount Airy, NC 27030-3532

Mailing address

364 N South St
Mount Airy, NC 27030-3532
Phone (336) 789-5050

Other names 1

  • Gates Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190217000003 NC Part B Supplier - Pharmacy 1355599051 Practice locations: Mount Airy, NC
O20200604003270 NC Part B Supplier - Independent Clinical Laboratory 1355599051 Practice locations: Mount Airy, NC

National Provider Directory

National Provider Directory
Tax ID family
Gates Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

364 N South St
Mount Airy, NC 27030
Phone (336) 789-5050

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625529600000",
    "number": "1700154366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 N SOUTH ST",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270303532",
            "telephone_number": "336-789-5050",
            "fax_number": "336-786-7169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 N SOUTH ST",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270303532",
            "telephone_number": "336-789-5050",
            "fax_number": "336-786-7169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE MEDS RX",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-09",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A",
        "authorized_official_last_name": "KOS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-475-8706"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "11190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gates Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gates Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Airy, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.