Provider Demographics
NPI:1265036529
Name:WERLINE, GREGORY TRENT (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:TRENT
Last Name:WERLINE
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 1:2149 DAVIDSON RD
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-7810
Mailing Address - Country:US
Mailing Address - Phone:859-539-7820
Mailing Address - Fax:
Practice Address - Street 1:3200 KEN BALE BLVD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6025
Practice Address - Country:US
Practice Address - Phone:270-781-7727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist