Provider Demographics
NPI:1184691388
Name:D'AMOUR, GREG (PHARMD, RPH, PHC)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:D'AMOUR
Suffix:
Gender:M
Credentials:PHARMD, RPH, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-9753
Mailing Address - Country:US
Mailing Address - Phone:505-894-6921
Mailing Address - Fax:505-894-3311
Practice Address - Street 1:48 MARINA RD
Practice Address - Street 2:
Practice Address - City:ELEPHANT BUTTE
Practice Address - State:NM
Practice Address - Zip Code:87935-0348
Practice Address - Country:US
Practice Address - Phone:575-740-9123
Practice Address - Fax:505-894-3311
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP4143 PC 81835P1200X
NMPC000000081835P2201X, 1835P0018X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric