Provider Demographics
NPI:1255641718
Name:LULA, GREGORY SAMUEL (RPH)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SAMUEL
Last Name:LULA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E MORGAN CT
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2052
Mailing Address - Country:US
Mailing Address - Phone:843-304-1666
Mailing Address - Fax:
Practice Address - Street 1:721 N OKATIE HWY # 170
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8276
Practice Address - Country:US
Practice Address - Phone:843-304-1666
Practice Address - Fax:843-987-0023
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49203183500000X
IN26013139A183500000X
CTPCT0005692183500000X
NC17522183500000X
SC9775183500000X
GARPH021123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist