Provider Demographics
NPI:1124629738
Name:GRESS, GREGORY HUGH (RPH)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:HUGH
Last Name:GRESS
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 1:4441 LAKE RD W
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-2056
Mailing Address - Country:US
Mailing Address - Phone:440-812-7885
Mailing Address - Fax:440-417-0016
Practice Address - Street 1:6067 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2441
Practice Address - Country:US
Practice Address - Phone:440-417-0373
Practice Address - Fax:440-417-0016
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03314221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist