Provider Demographics
NPI:1689959751
Name:ALECKSON, GREGORY (PHARM D)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:ALECKSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WEST AVE S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4729
Mailing Address - Country:US
Mailing Address - Phone:608-796-2058
Mailing Address - Fax:608-796-2059
Practice Address - Street 1:900 WEST AVE S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4729
Practice Address - Country:US
Practice Address - Phone:608-796-2058
Practice Address - Fax:608-796-2059
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14137-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist