Individual
MR. GARY JOHN WEIDEMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1003 S BISHOP AVE, ROLLA, MO 65401-4437
(573) 364-6079
Mailing address
10575 COUNTY ROAD 2038, ROLLA, MO 65401-8462
(573) 368-2993
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
044150
MO
Other
Enumeration date
03/08/2010
Last updated
03/08/2010
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