Provider Demographics
NPI:1922024959
Name:LUKE, GREGG R (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:R
Last Name:LUKE
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 1:5331 W 2400 S
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:UT
Mailing Address - Zip Code:84325-9752
Mailing Address - Country:US
Mailing Address - Phone:435-755-9553
Mailing Address - Fax:
Practice Address - Street 1:550 E 1400 N STE K
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2450
Practice Address - Country:US
Practice Address - Phone:435-755-8424
Practice Address - Fax:453-755-8436
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT152169-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist