Provider Demographics
NPI:1700194362
Name:VINZ, GREGORY ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ROBERT
Last Name:VINZ
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 1:1870 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2702
Mailing Address - Country:US
Mailing Address - Phone:318-746-8401
Mailing Address - Fax:318-746-8402
Practice Address - Street 1:1870 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2702
Practice Address - Country:US
Practice Address - Phone:318-746-8401
Practice Address - Fax:318-746-8402
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist