Gateway Drug Store, Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

License

50-000971 Issued in SC

Legal business name

GATEWAY DRUG STORE, INC.

Practice address

3997 Meeting St
Loris, SC 29569-3053

Phone

(843) 756-5134

Fax

(843) 756-0689

NPI assigned

Oct 24, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Thomas Freddie Moore, RPH.

Title

President

Phone

(843) 756-5134

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831189679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3997 MEETING ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295693053",
            "telephone_number": "843-756-5134",
            "fax_number": "843-756-0689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3997 MEETING ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295693053",
            "telephone_number": "843-756-5134",
            "fax_number": "843-756-0689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY DRUG STORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "FREDDIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-756-5134",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "SC",
            "license": "50-000971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lillian Fong, MD
• Sandra Ford, RN
• Sheri Ford
• David Edward Garces, MD
• Gary J Barrett MD PA
• Tamara Geralds
• Ramiro Jay Godines, M.D.
• Starlette C Godwin
• Elizabeth Porter Gore, LPC
• Wanda W Grainger, FNP

• All providers in Loris, SC
• Pharmacy in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.