Provider Demographics
NPI:1497357917
Name:WRIGHT, GREGORY VERNON
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:VERNON
Last Name:WRIGHT
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 1:6150 KEATON LN
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9677
Mailing Address - Country:US
Mailing Address - Phone:270-443-2806
Mailing Address - Fax:
Practice Address - Street 1:3550 JAMES SANDERS BLVD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9159
Practice Address - Country:US
Practice Address - Phone:270-444-6992
Practice Address - Fax:270-444-6997
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist