Individual
DAVID GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6495 COUNTRY CLUB RD, MURPHYSBORO, IL 62966-5202
(618) 687-3478
(618) 687-3547
Mailing address
6495 COUNTRY CLUB RD, MURPHYSBORO, IL 62966-5202
(618) 687-3478
(618) 687-3547
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051039834
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306863683
NPI
IL
Enumeration date
09/20/2016
Last updated
09/20/2016
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