Provider Demographics
NPI:1194371179
Name:HERRMANN, GREG
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-1239
Mailing Address - Country:US
Mailing Address - Phone:812-547-4201
Mailing Address - Fax:812-547-7941
Practice Address - Street 1:1636 13TH ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-1239
Practice Address - Country:US
Practice Address - Phone:812-547-4201
Practice Address - Fax:812-547-7941
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018601A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist