Provider Demographics
NPI:1285668848
Name:MCGREGOR, MARK ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:MCGREGOR
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:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:NAHUNTA
Mailing Address - State:GA
Mailing Address - Zip Code:31553-0865
Mailing Address - Country:US
Mailing Address - Phone:912-462-6386
Mailing Address - Fax:912-462-7657
Practice Address - Street 1:118C MAIN STREET
Practice Address - Street 2:
Practice Address - City:NAHUNTA
Practice Address - State:GA
Practice Address - Zip Code:31553
Practice Address - Country:US
Practice Address - Phone:912-462-6386
Practice Address - Fax:912-462-7657
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist