Healthcare Provider Details

I. General information

NPI: 1518861152
Provider Name (Legal Business Name): FRED PATRICK GATTAS III PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W PORT PLZ STE 800
SAINT LOUIS MO
63146-3016
US

IV. Provider business mailing address

313 YORKTOWN SQUARE CT
SAINT CHARLES MO
63303-1759
US

V. Phone/Fax

Practice location:
  • Phone: 314-998-7459
  • Fax:
Mailing address:
  • Phone: 901-652-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2005002695
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: