Provider Demographics
NPI:1881927069
Name:SMITH, GREGORY C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38241 PROCTOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8019
Mailing Address - Country:US
Mailing Address - Phone:503-668-1384
Mailing Address - Fax:
Practice Address - Street 1:2727 W AGUA FRIA FWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3929
Practice Address - Country:US
Practice Address - Phone:623-869-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-06
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010918183500000X
NMRP00006896183500000X
AZS023937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist