Provider Demographics
NPI:1437550100
Name:GAW, JAMES ODELL (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ODELL
Last Name:GAW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 W TRUMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-0545
Mailing Address - Country:US
Mailing Address - Phone:573-893-2226
Mailing Address - Fax:573-893-5176
Practice Address - Street 1:2805 W TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-0545
Practice Address - Country:US
Practice Address - Phone:573-893-2226
Practice Address - Fax:573-893-5176
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist