Provider Demographics
NPI:1619084688
Name:LYTWAK, GREGORY JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOHN
Last Name:LYTWAK
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:RENNER BLD BASEMENT
Mailing Address - Street 2:220 RESERVIOR DRIVE
Mailing Address - City:TORRANCE
Mailing Address - State:PA
Mailing Address - Zip Code:15799
Mailing Address - Country:US
Mailing Address - Phone:724-459-4522
Mailing Address - Fax:749-459-4415
Practice Address - Street 1:S.R. 1014 TORRANCE ROAD RENNER BUILDING.
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:PA
Practice Address - Zip Code:15799
Practice Address - Country:US
Practice Address - Phone:724-459-4522
Practice Address - Fax:724-459-4415
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030147L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist