Provider Demographics
NPI:1508104837
Name:DEGRAMMONT, GREGORY JAMES (R PH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAMES
Last Name:DEGRAMMONT
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6753
Mailing Address - Country:US
Mailing Address - Phone:386-756-6175
Mailing Address - Fax:
Practice Address - Street 1:1660 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6753
Practice Address - Country:US
Practice Address - Phone:386-756-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist