Active NPI
Gavin Andrew Bettcher
- Pharmacist
- Bridgeton, MO
National Provider Identifier
1669119467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2021046236
- Practice address
- 12380 Saint Charles Rock Rd
Bridgeton, MO 63044-2504 - Phone
- (314) 738-0188
- Fax
- (314) 738-0284
- NPI assigned
- May 13, 2022
- Last updated
- May 13, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2021046236 | MO | Primary |
Addresses
Primary practice location
12380 Saint Charles Rock Rd
Bridgeton, MO 63044-2504
Mailing address
12380 Saint Charles Rock Rd
Bridgeton, MO 63044-2504
Phone (314) 738-0188
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021046236 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri CVS Pharmacy LLC | Past | Accepting new patients | |
| Missouri CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652400000000",
"number": "1669119467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12380 SAINT CHARLES ROCK RD",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442504",
"telephone_number": "314-738-0188",
"fax_number": "314-738-0284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12380 SAINT CHARLES ROCK RD",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442504",
"telephone_number": "314-738-0188",
"fax_number": "314-738-0284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETTCHER",
"first_name": "GAVIN",
"middle_name": "ANDREW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-05-13",
"last_updated": "2022-05-13",
"certification_date": "2022-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2021046236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, MO
- Berwald Surgical Medical Inc (David Berwald MD)
- Bruce Jay Berwald, MD
- David Morton Berwald, MD
- Best Affordable Choices LLC
- Best Medical Care LLC
- Colleen Bettger
- Beyond Better, Best Consumer Directed Services, LLC
- Beyond Better, Best Home Health Care Services, Limited Liability Corpo
- Beyond Qualified Home Care LLC
- Asif Bhutto, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.