Provider Demographics
NPI:1619271426
Name:GREGORY, KRISMA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISMA
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 EDGEWATER CORPORATE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-4526
Mailing Address - Country:US
Mailing Address - Phone:704-729-4536
Mailing Address - Fax:
Practice Address - Street 1:1040 EDGEWATER CORPORATE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-4526
Practice Address - Country:US
Practice Address - Phone:704-729-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18002183500000X
SC123811835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist