Provider Demographics
NPI:1225324643
Name:GRYFAKIS, GEORGE E (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:E
Last Name:GRYFAKIS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 E DUNDEE ROAD, TARGET 0753
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-2817
Mailing Address - Country:US
Mailing Address - Phone:847-202-5130
Mailing Address - Fax:847-202-5130
Practice Address - Street 1:1071 MEMORY LN
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2489
Practice Address - Country:US
Practice Address - Phone:847-726-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.030193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051030193OtherRPH REGISTRATION NUMBER IN ILLINOIS