Provider Demographics
NPI:1679150825
Name:WILLS, GREGORY SCOTT (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:WILLS
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 1:3861 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:PENN LAIRD
Mailing Address - State:VA
Mailing Address - Zip Code:22846-9627
Mailing Address - Country:US
Mailing Address - Phone:540-421-7392
Mailing Address - Fax:
Practice Address - Street 1:2010 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-2426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202010795OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS