Provider Demographics
NPI:1538482393
Name:CARMEN, GREGG
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:CARMEN
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 1:105 MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2230
Mailing Address - Country:US
Mailing Address - Phone:800-238-7828
Mailing Address - Fax:412-717-9335
Practice Address - Street 1:105 MALL BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2230
Practice Address - Country:US
Practice Address - Phone:800-238-7828
Practice Address - Fax:412-717-9335
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042045T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist