Provider Demographics
NPI:1598745218
Name:GRESKOVIC, GERARD A (RPH)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:A
Last Name:GRESKOVIC
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 1:640 WHITE BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1254
Mailing Address - Country:US
Mailing Address - Phone:570-585-2091
Mailing Address - Fax:570-963-2313
Practice Address - Street 1:125 SCRANTON POCONO HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2274
Practice Address - Country:US
Practice Address - Phone:570-963-2312
Practice Address - Fax:570-963-2313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038249L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy