Provider Demographics
NPI:1275968463
Name:MASTERSON, GREGG ANDREW (RPH)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:ANDREW
Last Name:MASTERSON
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 1:1150 S GARNETT RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-1822
Mailing Address - Country:US
Mailing Address - Phone:918-437-9677
Mailing Address - Fax:918-234-7861
Practice Address - Street 1:1150 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-1822
Practice Address - Country:US
Practice Address - Phone:918-437-9677
Practice Address - Fax:918-234-7861
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist