Provider Demographics
NPI:1003132598
Name:GREZULA, JOHN J (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:GREZULA
Suffix:
Gender:M
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:RTE 209 BOSSARDSVILLE RD
Mailing Address - Street 2:BOSSARDSVILLE RD
Mailing Address - City:SCIOTA
Mailing Address - State:PA
Mailing Address - Zip Code:18354
Mailing Address - Country:US
Mailing Address - Phone:570-992-6300
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 209 AND BOSSARDSVILLE RD.
Practice Address - Street 2:
Practice Address - City:SCIOTA
Practice Address - State:PA
Practice Address - Zip Code:18354
Practice Address - Country:US
Practice Address - Phone:570-992-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034703L183500000X, 1835G0303X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy