Provider Demographics
NPI:1609994615
Name:FOLCK, GREGORY L (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:FOLCK
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 1:37 LANE 110AA BIG OTTER LAKE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:IN
Mailing Address - Zip Code:46737
Mailing Address - Country:US
Mailing Address - Phone:260-833-2241
Mailing Address - Fax:260-624-3920
Practice Address - Street 1:1801 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2360
Practice Address - Country:US
Practice Address - Phone:260-624-3110
Practice Address - Fax:260-624-3920
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist