Provider Demographics
NPI:1750664546
Name:GARRETT, GARY LEROY (RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEROY
Last Name:GARRETT
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 1:896 WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIDDLESEX
Mailing Address - State:PA
Mailing Address - Zip Code:16159-2132
Mailing Address - Country:US
Mailing Address - Phone:724-528-8063
Mailing Address - Fax:
Practice Address - Street 1:900 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3336
Practice Address - Country:US
Practice Address - Phone:724-342-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP026494L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist