Provider Demographics
NPI:1831759927
Name:MUSSON, GREGGORY PAUL (PHARMACIST)
Entity type:Individual
Prefix:
First Name:GREGGORY
Middle Name:PAUL
Last Name:MUSSON
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 1:925 NOTCHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-7995
Mailing Address - Country:US
Mailing Address - Phone:614-327-2202
Mailing Address - Fax:
Practice Address - Street 1:402 E WILSON BRIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2366
Practice Address - Country:US
Practice Address - Phone:614-400-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033161331835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric