Provider Demographics
NPI:1720361017
Name:DEFRANCESCO, GARY PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:PAUL
Last Name:DEFRANCESCO
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 1:7341 WOLFRUN TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-4504
Mailing Address - Country:US
Mailing Address - Phone:618-628-3034
Mailing Address - Fax:618-628-3035
Practice Address - Street 1:1400 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1309
Practice Address - Country:US
Practice Address - Phone:314-534-3853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist