Provider Demographics
NPI:1417347972
Name:LOWERY, GREGORY (CPHT, PHARMACY TECH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:LOWERY
Suffix:
Gender:M
Credentials:CPHT, PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EDWARDS FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3318
Mailing Address - Country:US
Mailing Address - Phone:703-777-8059
Mailing Address - Fax:571-442-5299
Practice Address - Street 1:1200 EDWARDS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3318
Practice Address - Country:US
Practice Address - Phone:703-777-8059
Practice Address - Fax:571-442-5299
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230019883183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician