Provider Demographics
NPI:1851666267
Name:GREGOIRE, LEE MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:MICHAEL
Last Name:GREGOIRE
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 1:5050 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8602
Mailing Address - Country:US
Mailing Address - Phone:719-264-5019
Mailing Address - Fax:719-264-5016
Practice Address - Street 1:5050 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8602
Practice Address - Country:US
Practice Address - Phone:719-264-5019
Practice Address - Fax:719-264-5016
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist