Provider Demographics
NPI:1154331379
Name:KUCK, GREGG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:KUCK
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 1:543 TAYLOR AVE
Mailing Address - Street 2:PHARMACY SERVICE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1278
Mailing Address - Country:US
Mailing Address - Phone:614-257-5232
Mailing Address - Fax:614-257-5231
Practice Address - Street 1:543 TAYLOR AVE
Practice Address - Street 2:PHARMACY SERVICE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1278
Practice Address - Country:US
Practice Address - Phone:614-257-5232
Practice Address - Fax:614-257-5231
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-20044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist