Provider Demographics
NPI:1477918522
Name:LUTE, GREGORY
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:LUTE
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 1:10731 ROUTE 403 HWY N
Mailing Address - Street 2:
Mailing Address - City:CLYMER
Mailing Address - State:PA
Mailing Address - Zip Code:15728-8124
Mailing Address - Country:US
Mailing Address - Phone:814-886-2677
Mailing Address - Fax:814-884-0175
Practice Address - Street 1:1212 2ND ST
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1148
Practice Address - Country:US
Practice Address - Phone:814-886-2677
Practice Address - Fax:814-884-0175
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist