Provider Demographics
NPI:1609120443
Name:WEST, GREGORY BRYAN
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:BRYAN
Last Name:WEST
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 1:139 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-3125
Mailing Address - Country:US
Mailing Address - Phone:828-245-4591
Mailing Address - Fax:828-245-3273
Practice Address - Street 1:139 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3125
Practice Address - Country:US
Practice Address - Phone:828-245-4591
Practice Address - Fax:828-245-3273
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC006625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist