MEDICARE: GREG CLOUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03324067	OH

General Provider Information

NPI Number	:	1033739909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREG CLOUSE

Provider Business Mailing Address
First Line	:	1321 HAROLD STEWART PKWY
Second Line	:
City	:	PATASKALA
State	:	OH
Zip	:	43062-7595
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E MAIN ST
Second Line	:
City	:	HEBRON
State	:	OH
Zip	:	43025-8006
Country	:	US
Telephone Number	:	740-928-0795
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2020
Last Update Date	:	04/21/2020

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Directions to “ GREG CLOUSE ” Practice Location

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