Provider Demographics
NPI:1639464126
Name:FROMMELT, GREG (RPH)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:FROMMELT
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 1:2910 1ST AVE S
Mailing Address - Street 2:TARGET 0878
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2972
Mailing Address - Country:US
Mailing Address - Phone:515-573-7202
Mailing Address - Fax:515-573-7202
Practice Address - Street 1:2910 1ST AVE S
Practice Address - Street 2:TARGET 0878
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2972
Practice Address - Country:US
Practice Address - Phone:515-573-7202
Practice Address - Fax:515-573-7202
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist