Provider Demographics
NPI:1467936534
Name:PELLEGRINI, GREGORY M (PHARMD, RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:M
Last Name:PELLEGRINI
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E MERCED ST
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CA
Mailing Address - Zip Code:93625-2312
Mailing Address - Country:US
Mailing Address - Phone:559-834-1606
Mailing Address - Fax:559-834-5841
Practice Address - Street 1:111 E MERCED ST
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CA
Practice Address - Zip Code:93625-2312
Practice Address - Country:US
Practice Address - Phone:559-834-1606
Practice Address - Fax:559-834-5841
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist