Healthcare Provider Details

I. General information

NPI: 1972464964
Provider Name (Legal Business Name): GREGORY JACOB PIERRE LOUIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-5900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS69220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: