Provider Demographics
NPI:1902834542
Name:PAPA, GREGORY WILLIAM (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:WILLIAM
Last Name:PAPA
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 1:23 BRANTLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1126
Mailing Address - Country:US
Mailing Address - Phone:856-232-9107
Mailing Address - Fax:
Practice Address - Street 1:42 LAUREL RD E
Practice Address - Street 2:SUITE 1900
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-346-3535
Practice Address - Fax:856-346-4953
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00255700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist