Provider Demographics
NPI:1437599073
Name:GREAVES, MARK A (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:GREAVES
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 1:450 OLD SMIZER MILL RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3553
Mailing Address - Country:US
Mailing Address - Phone:636-349-2666
Mailing Address - Fax:636-530-3018
Practice Address - Street 1:450 OLD SMIZER MILL RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3553
Practice Address - Country:US
Practice Address - Phone:636-349-2666
Practice Address - Fax:636-530-3018
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0420591835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist