Provider Demographics
NPI:1962012930
Name:GREGOROWICZ, ALEX JOHN
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:JOHN
Last Name:GREGOROWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 N DESPLAINES ST APT 2208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1352
Mailing Address - Country:US
Mailing Address - Phone:502-409-2463
Mailing Address - Fax:
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:502-409-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0192131835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY019213OtherKENTUCKY PHARMACIST LICENSE NUMBER
IL051.300422OtherILLINOIS PHARMACIST LICENSE NUMBER