Provider Demographics
NPI:1922610716
Name:GREGORIADES, GREGORY DIMITRIOS (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DIMITRIOS
Last Name:GREGORIADES
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2120
Mailing Address - Country:US
Mailing Address - Phone:502-897-1681
Mailing Address - Fax:
Practice Address - Street 1:2106 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2120
Practice Address - Country:US
Practice Address - Phone:502-897-1681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist