Provider Demographics
NPI:1265100135
Name:GREGORY, JOHN ROBERT (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:GREGORY
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 1:6917 WATHEN LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-9153
Mailing Address - Country:US
Mailing Address - Phone:270-860-4915
Mailing Address - Fax:
Practice Address - Street 1:3030 BURLEW BLVD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6486
Practice Address - Country:US
Practice Address - Phone:270-685-4931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist