Provider Demographics
NPI:1609168210
Name:BERRY, GREGORY E (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:E
Last Name:BERRY
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 1:1021 LOCKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6001
Mailing Address - Country:US
Mailing Address - Phone:407-977-9020
Mailing Address - Fax:407-977-9030
Practice Address - Street 1:1021 LOCKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6001
Practice Address - Country:US
Practice Address - Phone:407-977-9020
Practice Address - Fax:407-977-9030
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist