Healthcare Provider Details

I. General information

NPI: 1912246604
Provider Name (Legal Business Name): DONETTE A GILLESPIE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 MID RIVERS MALL DR
SAINT PETERS MO
63376-2150
US

IV. Provider business mailing address

1590 ROYALTON CT
O FALLON MO
63366-1167
US

V. Phone/Fax

Practice location:
  • Phone: 636-970-3222
  • Fax:
Mailing address:
  • Phone: 636-544-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number044183
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: