Basic Information
| Provider Information | |||||||||
| NPI: | 1437550100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAW | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ODELL | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2805 W TRUMAN BLVD | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651090545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738932226 | ||||||||
| FaxNumber: | 5738935176 | ||||||||
| Practice Location | |||||||||
| Address1: | 2805 W TRUMAN BLVD | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651090545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738932226 | ||||||||
| FaxNumber: | 5738935176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2014 | ||||||||
| LastUpdateDate: | 09/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 040989 | MO | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.