Provider Demographics
NPI:1780988022
Name:STERN, GREGG MICHAEL (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:MICHAEL
Last Name:STERN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:SMITHERS
Mailing Address - State:WV
Mailing Address - Zip Code:25186-0577
Mailing Address - Country:US
Mailing Address - Phone:304-442-2152
Mailing Address - Fax:304-442-5159
Practice Address - Street 1:505 VIRGINIA AVE.
Practice Address - Street 2:
Practice Address - City:SMITHERS
Practice Address - State:WV
Practice Address - Zip Code:25186-0577
Practice Address - Country:US
Practice Address - Phone:304-442-2152
Practice Address - Fax:304-442-5159
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52541835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist