Provider Demographics
NPI:1033714977
Name:GRAVETTE, DAVID EARL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARL
Last Name:GRAVETTE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2522
Mailing Address - Country:US
Mailing Address - Phone:256-249-4962
Mailing Address - Fax:
Practice Address - Street 1:2 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2522
Practice Address - Country:US
Practice Address - Phone:256-249-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist