Provider Demographics
NPI:1770902512
Name:DYLE, GREGORY A (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:DYLE
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 1:368 NE FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3088
Mailing Address - Country:US
Mailing Address - Phone:386-292-8050
Mailing Address - Fax:
Practice Address - Street 1:368 NE FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3088
Practice Address - Country:US
Practice Address - Phone:386-292-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS22389OtherFLORIDA DEPARTMENT OF HEALTH-PHARMACIST
298074OtherNATIONAL ASS OF BOARDS OF PHARMACY