Provider Demographics
NPI:1700886207
Name:MEDLEY, GREGORY DANIEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DANIEL
Last Name:MEDLEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13044 CAMINITO DEL ROCIO
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3621
Mailing Address - Country:US
Mailing Address - Phone:858-472-0906
Mailing Address - Fax:
Practice Address - Street 1:9888 GENESEE AVE
Practice Address - Street 2:LJ-18
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1276
Practice Address - Country:US
Practice Address - Phone:858-626-6081
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist