Healthcare Provider Details

I. General information

NPI: 1407842412
Provider Name (Legal Business Name): THOMAS B GREGORY PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE DEPARTMENT OF PHARMACY
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

3801 S NATIONAL AVE DEPARTMENT OF PHARMACY
SPRINGFIELD MO
65807-5210
US

V. Phone/Fax

Practice location:
  • Phone: 414-225-9746
  • Fax: 417-269-5796
Mailing address:
  • Phone: 414-225-9746
  • Fax: 417-269-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2004034216
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number1-14031
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: