Provider Demographics
NPI:1457873903
Name:HADLOCK, GREGORY CARLSON (PHARMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CARLSON
Last Name:HADLOCK
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 WELLESLEY DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1133
Mailing Address - Country:US
Mailing Address - Phone:801-706-9962
Mailing Address - Fax:
Practice Address - Street 1:301 SAN MATEO BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5629
Practice Address - Country:US
Practice Address - Phone:505-262-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000085681835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty