Provider Demographics
NPI:1538563713
Name:GREGG, NICHOLAS (PHARMACIST)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GREGG
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1322
Mailing Address - Country:US
Mailing Address - Phone:301-334-2197
Mailing Address - Fax:301-334-3577
Practice Address - Street 1:20 N 3RD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1322
Practice Address - Country:US
Practice Address - Phone:301-334-2197
Practice Address - Fax:301-334-3577
Is Sole Proprietor?:No
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist