Provider Demographics
NPI:1821833419
Name:BRIGGS, GREGORY (RPH)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:BRIGGS
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 1:8751 MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-4014
Mailing Address - Country:US
Mailing Address - Phone:317-840-7412
Mailing Address - Fax:
Practice Address - Street 1:5981 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-9355
Practice Address - Country:US
Practice Address - Phone:317-335-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021259A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist