Provider Demographics
NPI:1508152539
Name:MEADOR, DAVID J (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:MEADOR
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 1:1851 VERNACI DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-6174
Mailing Address - Country:US
Mailing Address - Phone:636-825-7701
Mailing Address - Fax:636-825-7701
Practice Address - Street 1:1851 VERNACI DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-6174
Practice Address - Country:US
Practice Address - Phone:636-825-7701
Practice Address - Fax:636-825-7701
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist