Provider Demographics
NPI:1457836728
Name:GREUEL, COLBY
Entity Type:Individual
Prefix:DR
First Name:COLBY
Middle Name:
Last Name:GREUEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 S YUKON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-6621
Mailing Address - Country:US
Mailing Address - Phone:918-321-4054
Mailing Address - Fax:918-552-1030
Practice Address - Street 1:12100 S YUKON AVE STE A
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-6621
Practice Address - Country:US
Practice Address - Phone:918-321-4054
Practice Address - Fax:918-552-1030
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist