Provider Demographics
NPI:1396838702
Name:CHATTERTON, GREGORY BRADFORD (RPH CPH)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:BRADFORD
Last Name:CHATTERTON
Suffix:
Gender:M
Credentials:RPH CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21197 WHITE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1716
Mailing Address - Country:US
Mailing Address - Phone:561-716-1127
Mailing Address - Fax:561-487-6043
Practice Address - Street 1:21197 WHITE OAK AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1716
Practice Address - Country:US
Practice Address - Phone:561-716-1127
Practice Address - Fax:561-487-6043
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist