Provider Demographics
NPI:1326403262
Name:GRESH, EUGENE W JR (RPH)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:W
Last Name:GRESH
Suffix:JR
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 1:520 HARTFORD TPKE
Mailing Address - Street 2:UNIT D
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5037
Mailing Address - Country:US
Mailing Address - Phone:860-979-0089
Mailing Address - Fax:860-979-0091
Practice Address - Street 1:520 HARTFORD TPKE
Practice Address - Street 2:UNIT D
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5037
Practice Address - Country:US
Practice Address - Phone:860-979-0089
Practice Address - Fax:860-979-0091
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist