Provider Demographics
NPI:1740558808
Name:SMITH, GREGG MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:MICHAEL
Last Name:SMITH
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 1:2014 SERENITY ST
Mailing Address - Street 2:
Mailing Address - City:SCHWENKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19473-2070
Mailing Address - Country:US
Mailing Address - Phone:610-584-1083
Mailing Address - Fax:
Practice Address - Street 1:4 NESHAMINY INTERPLEX DR
Practice Address - Street 2:SUITE 111
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6944
Practice Address - Country:US
Practice Address - Phone:215-639-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040437R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist