Healthcare Provider Details

I. General information

NPI: 1538307541
Provider Name (Legal Business Name): GREGORY WARNER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 S MARINE CORPS DR
TAMUNING GU
96913-3539
US

IV. Provider business mailing address

PO BOX 6578
TAMUNING GU
96931-6578
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-5825
  • Fax: 671-647-3598
Mailing address:
  • Phone: 671-646-5825
  • Fax: 671-647-3598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH51127
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number260882-1701
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH145
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: