Provider Demographics
NPI:1568786184
Name:GREGOIRE, WAYNE THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:THOMAS
Last Name:GREGOIRE
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 1:1382 DEEP RUN RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7025
Mailing Address - Country:US
Mailing Address - Phone:630-420-9884
Mailing Address - Fax:
Practice Address - Street 1:1199 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8568
Practice Address - Country:US
Practice Address - Phone:630-357-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.031602183500000X
IN26013943A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist