Provider Demographics
NPI:1164704904
Name:GREGOR, JOHN CLAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CLAY
Last Name:GREGOR
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 1:1 MOHEGAN SUN BLVD
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1355
Mailing Address - Country:US
Mailing Address - Phone:860-859-9764
Mailing Address - Fax:860-887-5189
Practice Address - Street 1:1 MOHEGAN SUN BLVD
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1355
Practice Address - Country:US
Practice Address - Phone:860-859-9764
Practice Address - Fax:860-887-5189
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0005503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist