Provider Demographics
NPI:1609082437
Name:GRIESS, GREGORY JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JAMES
Last Name:GRIESS
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 1:119 DECKER ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1068
Mailing Address - Country:US
Mailing Address - Phone:570-662-7946
Mailing Address - Fax:
Practice Address - Street 1:7 TROY ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-1403
Practice Address - Country:US
Practice Address - Phone:570-673-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044341L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist