Provider Demographics
NPI:1952713232
Name:DIETMEYER, GAIL (PHARMD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:DIETMEYER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 E JACARANDA ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-3588
Mailing Address - Country:US
Mailing Address - Phone:480-760-1324
Mailing Address - Fax:
Practice Address - Street 1:1000 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5154
Practice Address - Country:US
Practice Address - Phone:417-269-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016606183500000X
MO2022021919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist