Provider Demographics
NPI:1497041255
Name:GRESH, BRIAN J (RPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:GRESH
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 1:90 ELM ST
Mailing Address - Street 2:T-1255
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-741-8054
Mailing Address - Fax:860-741-8054
Practice Address - Street 1:90 ELM ST
Practice Address - Street 2:T-1255
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3770
Practice Address - Country:US
Practice Address - Phone:860-741-8054
Practice Address - Fax:860-741-8054
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist