Provider Demographics
NPI:1467886176
Name:GOOSSENS, GREGORY RIEN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:RIEN
Last Name:GOOSSENS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:HOTCHKISS
Mailing Address - State:CO
Mailing Address - Zip Code:81419
Mailing Address - Country:US
Mailing Address - Phone:970-319-0556
Mailing Address - Fax:
Practice Address - Street 1:215 6 TH ST
Practice Address - Street 2:
Practice Address - City:HOTCHKISS
Practice Address - State:CO
Practice Address - Zip Code:81419
Practice Address - Country:US
Practice Address - Phone:970-872-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist