MEDICARE: GARY PAUL DEFRANCESCO R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	043231	MO

General Provider Information

NPI Number	:	1720361017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY PAUL DEFRANCESCO R.PH.

Provider Business Mailing Address
First Line	:	7341 WOLFRUN TRL
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-4504
Country	:	US
Telephone Number	:	618-628-3034
Fax Number	:	618-628-3035

Provider Business Practice Location Address
First Line	:	1400 N GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-1309
Country	:	US
Telephone Number	:	314-534-3853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/22/2011

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