Provider Demographics
NPI:1215258611
Name:LEVITAN, GREGG (RPH)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:
Last Name:LEVITAN
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 1:9300 LAKESIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4953
Mailing Address - Country:US
Mailing Address - Phone:410-363-8066
Mailing Address - Fax:410-363-2647
Practice Address - Street 1:9300 LAKESIDE BLVD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4953
Practice Address - Country:US
Practice Address - Phone:410-363-8066
Practice Address - Fax:410-363-2647
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18253183500000X
IL051-033254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist