Provider Demographics
NPI:1205453412
Name:GREITZ, GEORGE JOSEPH IV (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:GREITZ
Suffix:IV
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:GREITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:15515 JUANITA WOODINVILLE WAY NE UNIT C204
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1583
Mailing Address - Country:US
Mailing Address - Phone:732-779-6626
Mailing Address - Fax:
Practice Address - Street 1:10020 NE 137TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5221
Practice Address - Country:US
Practice Address - Phone:425-821-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61083015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH61083015OtherWA PHARMACIST LICENSE