Provider Demographics
NPI:1093382483
Name:GREGG, CLAUSY SABINE (VA60015439)
Entity Type:Individual
Prefix:
First Name:CLAUSY
Middle Name:SABINE
Last Name:GREGG
Suffix:
Gender:F
Credentials:VA60015439
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14035 NE WOODINVILLE DUVALL RD
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8504
Mailing Address - Country:US
Mailing Address - Phone:425-485-6468
Mailing Address - Fax:
Practice Address - Street 1:14035 NE WOODINVILLE DUVALL RD
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8504
Practice Address - Country:US
Practice Address - Phone:425-485-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60015439183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician