Provider Demographics
NPI:1811932296
Name:GREGG, INC.
Entity type:Organization
Organization Name:GREGG, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:508-778-5928
Mailing Address - Street 1:596 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3465
Mailing Address - Country:US
Mailing Address - Phone:508-778-5928
Mailing Address - Fax:
Practice Address - Street 1:596 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3465
Practice Address - Country:US
Practice Address - Phone:508-778-5928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15874183500000X
MADS26383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2226632OtherNCPDP #
MA0405329Medicaid