Provider Demographics
NPI:1376681759
Name:GREGORY, JOHN C (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:GREGORY
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 1:5082 GOLD MINE HWY
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-8074
Mailing Address - Country:US
Mailing Address - Phone:803-475-5143
Mailing Address - Fax:
Practice Address - Street 1:605 S HAMPTON ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-2002
Practice Address - Country:US
Practice Address - Phone:803-475-6979
Practice Address - Fax:803-475-6979
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist