Provider Demographics
NPI:1720497662
Name:NAZARETH, GREGORY RICHARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:RICHARD
Last Name:NAZARETH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9870 BAY LEAF CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4445
Mailing Address - Country:US
Mailing Address - Phone:954-415-6895
Mailing Address - Fax:
Practice Address - Street 1:9870 BAY LEAF CT
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4445
Practice Address - Country:US
Practice Address - Phone:954-415-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19785183500000X
RIRPH03896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist