Provider Demographics
NPI:1508074758
Name:SONTAG, GREGORY MATTHEW (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MATTHEW
Last Name:SONTAG
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 1:10217 TESSON VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7901
Mailing Address - Country:US
Mailing Address - Phone:314-544-6135
Mailing Address - Fax:
Practice Address - Street 1:2709 HIGH RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2202
Practice Address - Country:US
Practice Address - Phone:636-677-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist