Healthcare Provider Details

I. General information

NPI: 1073807178
Provider Name (Legal Business Name): GREGORY M WURL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 STATE RD T-2167
NORTH DARTMOUTH MA
02747-4309
US

IV. Provider business mailing address

479 STATE RD T-2167
NORTH DARTMOUTH MA
02747-4309
US

V. Phone/Fax

Practice location:
  • Phone: 508-979-7531
  • Fax: 508-979-7536
Mailing address:
  • Phone: 508-979-7531
  • Fax: 508-979-7536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH22916
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: