Provider Demographics
NPI:1659501245
Name:UPHAM, GREG C JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:C
Last Name:UPHAM
Suffix:JR
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 1:8700 W TRAIL LAKE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8205
Mailing Address - Country:US
Mailing Address - Phone:901-309-1404
Mailing Address - Fax:
Practice Address - Street 1:8700 W TRAIL LAKE DR STE 205
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8205
Practice Address - Country:US
Practice Address - Phone:423-276-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210507183500000X
FLPS0044823183500000X
TN33570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist