Provider Demographics
NPI:1619269420
Name:BADWAY, GREGORY THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:THOMAS
Last Name:BADWAY
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 1:18816 NAUTICAL DR APT 12
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8061
Mailing Address - Country:US
Mailing Address - Phone:704-895-6333
Mailing Address - Fax:
Practice Address - Street 1:18816 NAUTICAL DR APT 12
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8061
Practice Address - Country:US
Practice Address - Phone:704-895-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist