Provider Demographics
NPI:1245507151
Name:GREMAUD, DAVID NEIL (R PH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:NEIL
Last Name:GREMAUD
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N FLORISSANT RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-1942
Mailing Address - Country:US
Mailing Address - Phone:314-521-4518
Mailing Address - Fax:314-522-6214
Practice Address - Street 1:190 N FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-1942
Practice Address - Country:US
Practice Address - Phone:314-521-4518
Practice Address - Fax:314-522-6214
Is Sole Proprietor?:No
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist