Provider Demographics
NPI:1700479441
Name:GRECO, COLLEEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:GRECO
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 1:6 CARRIAGE CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-3218
Mailing Address - Country:US
Mailing Address - Phone:314-583-3973
Mailing Address - Fax:
Practice Address - Street 1:2248 WELSCH INDUSTRIAL CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4222
Practice Address - Country:US
Practice Address - Phone:314-356-9830
Practice Address - Fax:314-356-9850
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001003658183500000X, 1835G0303X
IL051.293641183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist