Provider Demographics
NPI:1629674445
Name:GINSBURG, GARY MARC (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:MARC
Last Name:GINSBURG
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 1:4267 SUNRISE FLATS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2977
Mailing Address - Country:US
Mailing Address - Phone:203-733-9964
Mailing Address - Fax:
Practice Address - Street 1:47 LAKE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5259
Practice Address - Country:US
Practice Address - Phone:203-778-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5501333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy