Provider Demographics
NPI:1851828529
Name:GREGORY, CHARISSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1996 TIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6741
Mailing Address - Country:US
Mailing Address - Phone:419-427-3662
Mailing Address - Fax:
Practice Address - Street 1:1996 TIFFIN AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6741
Practice Address - Country:US
Practice Address - Phone:419-427-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225095183500000X
KY011011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist