Provider Demographics
NPI:1073047676
Name:GREATHOUSE, GWENDOLYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2033
Mailing Address - Country:US
Mailing Address - Phone:814-443-5116
Mailing Address - Fax:
Practice Address - Street 1:225 S CENTER AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2033
Practice Address - Country:US
Practice Address - Phone:814-443-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist