Provider Demographics
NPI:1740725548
Name:CERIO, GREGORY
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:CERIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 BLUESLATE CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-6088
Mailing Address - Country:US
Mailing Address - Phone:866-448-8040
Mailing Address - Fax:
Practice Address - Street 1:11001 ROOSEVELT BLVD N
Practice Address - Street 2:SUITE 1400
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2354
Practice Address - Country:US
Practice Address - Phone:866-448-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist