Provider Demographics
NPI:1932294485
Name:JONAS, GREGORY A (PHARMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:JONAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 WILLOW GROVE DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820
Mailing Address - Country:US
Mailing Address - Phone:517-669-8593
Mailing Address - Fax:517-336-5638
Practice Address - Street 1:1525 W. LAKE LANSING
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-336-5636
Practice Address - Fax:517-336-5638
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist