Provider Demographics
NPI:1528348174
Name:STEWART, GREGORY DANIEL (RPH)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DANIEL
Last Name:STEWART
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 1:33 S PERE MARQUETTE HWY
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2441
Mailing Address - Country:US
Mailing Address - Phone:231-845-5399
Mailing Address - Fax:
Practice Address - Street 1:33 S PERE MARQUETTE HWY
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2441
Practice Address - Country:US
Practice Address - Phone:231-845-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist