Provider Demographics
NPI:1972882603
Name:SMITH, GREGORY DOUGLAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DOUGLAS
Last Name:SMITH
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 1:1420 WEST NEWLINS RD
Mailing Address - Street 2:
Mailing Address - City:FORKS TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6580 SNOWDRIFT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9331
Practice Address - Country:US
Practice Address - Phone:610-395-5170
Practice Address - Fax:610-395-5178
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist