Provider Demographics
NPI:1528197860
Name:BEATTIE, GREGORY (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:BEATTIE
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 1:1005 HAZELTON ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-3208
Mailing Address - Country:US
Mailing Address - Phone:231-347-5615
Mailing Address - Fax:231-347-4046
Practice Address - Street 1:630 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2233
Practice Address - Country:US
Practice Address - Phone:231-347-8282
Practice Address - Fax:231-347-4046
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist