David Gardner
Individual provider Active NPI Pharmacist · Murphysboro, IL
NPI 1891243705 · NPPES record last updated Sep 20, 2016
Key facts
- NPI
- 1891243705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051039834 (IL)
- Practice address
- 6495 Country Club Rd
Murphysboro, IL 62966-5202 - Phone
- (618) 687-3478
- Fax
- (618) 687-3547
- NPI assigned
- Sep 20, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051039834 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051039834 | IL | Yes |
Addresses
Primary practice location
6495 Country Club Rd
Murphysboro, IL 62966-5202
Mailing address
6495 Country Club Rd
Murphysboro, IL 62966-5202
Phone (618) 687-3478
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306863683 | Other | IL | NPI |
Other providers in Murphysboro, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.