Provider Demographics
NPI:1912246604
Name:GILLESPIE, DONETTE A (RPH)
Entity type:Individual
Prefix:MRS
First Name:DONETTE
Middle Name:A
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 ROYALTON CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1167
Mailing Address - Country:US
Mailing Address - Phone:636-544-4898
Mailing Address - Fax:
Practice Address - Street 1:530 MID RIVERS MALL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2150
Practice Address - Country:US
Practice Address - Phone:636-970-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0441831835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric