Provider Demographics
NPI:1821412248
Name:BEHREND, GREGG (RPH)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:BEHREND
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 1:4400 OLE BRICKYARD CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3066
Mailing Address - Country:US
Mailing Address - Phone:502-454-0803
Mailing Address - Fax:
Practice Address - Street 1:9905 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3943
Practice Address - Country:US
Practice Address - Phone:502-995-2110
Practice Address - Fax:502-995-2165
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011755183500000X
IL051.039615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist