Provider Demographics
NPI:1831499821
Name:GRECO, GARY JOHN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOHN
Last Name:GRECO
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 1:16002 W PAPAGO ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7905
Mailing Address - Country:US
Mailing Address - Phone:917-402-6543
Mailing Address - Fax:
Practice Address - Street 1:16002 W PAPAGO ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7905
Practice Address - Country:US
Practice Address - Phone:917-402-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019866183500000X
NYI054684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist