Provider Demographics
NPI:1093786873
Name:CROSS, GREGORY DEAN (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DEAN
Last Name:CROSS
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 1:616 EAST 1 STREET
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683
Mailing Address - Country:US
Mailing Address - Phone:660-359-4157
Mailing Address - Fax:660-359-4168
Practice Address - Street 1:616 EAST 1 STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683
Practice Address - Country:US
Practice Address - Phone:660-359-4157
Practice Address - Fax:660-359-4168
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0289640001Medicare ID - Type Unspecified