Provider Demographics
NPI:1881284289
Name:ARNETT, GREGORY CARL
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:CARL
Last Name:ARNETT
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 1:99 S HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1168
Mailing Address - Country:US
Mailing Address - Phone:480-926-5221
Mailing Address - Fax:
Practice Address - Street 1:99 S HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1168
Practice Address - Country:US
Practice Address - Phone:480-926-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-0110430OtherFEDERAL TAX ID
AZY004757OtherSTATE LIC