Provider Demographics
NPI:1437573409
Name:DEGREGORY, THERESA (RPH)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:DEGREGORY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-4153
Mailing Address - Country:US
Mailing Address - Phone:502-326-5210
Mailing Address - Fax:502-326-5265
Practice Address - Street 1:4100 TOWNE CENTER DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-4153
Practice Address - Country:US
Practice Address - Phone:502-326-5210
Practice Address - Fax:502-326-5265
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist