Provider Demographics
NPI:1437637436
Name:FARRIS, GREGORY MARK (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MARK
Last Name:FARRIS
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 1:4563 20TH CT S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2214
Mailing Address - Country:US
Mailing Address - Phone:503-581-3419
Mailing Address - Fax:503-581-1134
Practice Address - Street 1:750 BROWNING AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3806
Practice Address - Country:US
Practice Address - Phone:503-581-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0007871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist