Provider Demographics
NPI:1649743816
Name:PHILLIPS, GREGORY REID (PHARMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:REID
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CROSS LINK RD STE 51
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4186
Mailing Address - Country:US
Mailing Address - Phone:919-821-1407
Mailing Address - Fax:
Practice Address - Street 1:1601 CROSS LINK RD STE 51
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4186
Practice Address - Country:US
Practice Address - Phone:919-821-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist