Provider Demographics
NPI:1821613498
Name:GASTON, DADRION ANNETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DADRION
Middle Name:ANNETTE
Last Name:GASTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DADRION
Other - Middle Name:ANNETTE
Other - Last Name:BRASSFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17201 SCOTT CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72732-9481
Mailing Address - Country:US
Mailing Address - Phone:479-640-5153
Mailing Address - Fax:
Practice Address - Street 1:702 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72716-6209
Practice Address - Country:US
Practice Address - Phone:479-273-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11849183500000X
MO2005009704183500000X
ARPD09905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty