Provider Demographics
NPI:1285826099
Name:STANCROFF, GREGORY GORDON (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:GORDON
Last Name:STANCROFF
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 1:610 CEDAR PINES DR NE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-8205
Mailing Address - Country:US
Mailing Address - Phone:616-887-6832
Mailing Address - Fax:
Practice Address - Street 1:2680 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6934
Practice Address - Country:US
Practice Address - Phone:616-224-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist