Provider Demographics
NPI:1427760875
Name:PRIMUTH, GREGORY (RPH)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:PRIMUTH
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 1:910 S MICHIGAN AVE APT 512
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2268
Mailing Address - Country:US
Mailing Address - Phone:404-664-6620
Mailing Address - Fax:
Practice Address - Street 1:100 W RANDOLPH ST STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3377
Practice Address - Country:US
Practice Address - Phone:404-664-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.288249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist