Provider Demographics
NPI:1205042074
Name:GREB, ROSE M (RPH)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:GREB
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 5TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-2822
Mailing Address - Country:US
Mailing Address - Phone:701-845-3348
Mailing Address - Fax:
Practice Address - Street 1:102 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-4005
Practice Address - Country:US
Practice Address - Phone:701-265-3332
Practice Address - Fax:701-265-3370
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist