Healthcare Provider Details

I. General information

NPI: 1952713232
Provider Name (Legal Business Name): GAIL DIETMEYER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST
SPRINGFIELD MO
65807-5154
US

IV. Provider business mailing address

5821 E JACARANDA ST
MESA AZ
85205-3588
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-5584
  • Fax:
Mailing address:
  • Phone: 480-760-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS016606
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2022021919
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: