Provider Demographics
NPI:1225076037
Name:KREMER, GARY LEE (R PH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:KREMER
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 BLUFF FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-5026
Mailing Address - Country:US
Mailing Address - Phone:314-846-6782
Mailing Address - Fax:
Practice Address - Street 1:3844 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:SUNSET HILLS
Practice Address - State:MO
Practice Address - Zip Code:63127-1368
Practice Address - Country:US
Practice Address - Phone:314-525-0415
Practice Address - Fax:314-525-0401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2003002133OtherSTATE PHARMACY LICENSE NO
MO2003002133OtherSTATE PHARMACY LICENSE NO
BF8159685OtherDEA LICENSE NO.